bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toxic dilatation of the colon in Chagas' disease
Authors: Kobayasi S , Mendes E F , Rodrigues M A M , Franco M F 
Published: March 2007

Abstract
Toxic megacolon occurs in colitis of differing aetiology. This report describes 15 patients with chagasic megacolon with this complication. The clinical signs and symptoms in all patients were pain and progressive abdominal distension accompanied by fever, severe toxaemia and shock. Seven patients developed this clinical pattern after manual removal of faeces. The remaining patients had pain and abdominal distension followed by signs of severe toxaemia when first examined. Nine patients underwent total colectomy with ileostomy (one death), four partial colectomy (all died) and two received medical treatment (both died). At autopsy, three of the four patients undergoing partial colectomy had residual colitis and enteritis. The surgical procedure of choice for this complication of chagasic megacolon is total colectomy.
Evidence from dynamic integrated proctography to redefine anismus
Authors: Roberts J P , Womack N R , Hallan R I , Thorpe A C , Williams N S 
Published: March 2007

Abstract
The role of anismus in the aetiology of defective rectal evacuation was investigated by dynamic integrated proctography in 20 controls and 71 constipated patients. Normal parameters were defined and compared between 21 constipated patients with poor evacuation during proctography (&lt;40 per cent of contrast evacuated; group 1) and 50 who evacuated fully (&gt;90 per cent of contrast evacuated; group 2). Nine patients in group 1 failed to evacuate. Radiological abnormalities of the rectum were recorded in all groups but obstructed evacuation was not observed. Anismus (defined as a recruitment of puborectalis electromyogram (EMG) activity of &gt;50 per cent) was significantly more common in group 1 than group 2 patients (14 of 21 versus 12 of 50, P &lt; 0.01) and present in seven of those unable to evacuate. Eight patients in group 1 failed to raise intrarectal pressure &gt;50 cmH2O compared with two in group 2 (P &lt; 0.001). Six patients in group 1 demonstrated both anismus and inability to raise intrarectal pressure, which may combine to cause defective evacuation. EMG recruitment alone is insufficient to diagnose anismus. Definition should be based on three criteria: demonstration of puborectalis EMG recruitment of &gt;50 per cent; evidence of an adequate level of intrarectal pressure (&gt;50 cmH2O) on straining; and presence of defective evacuation.
Long-term reduction of intimal hyperplasia by the selective alpha-1 adrenergic antagonist doxazosin
Authors: Vashisht R , Sian M , Franks P J , O'Malley M K 
Published: March 2007

Abstract
Studies have shown that α1- adrenergic blockade reduces intimal hyperplasia in the rabbit aorta. In this study a selective α1-adrenergic antagonist, doxazosin, has been used to examine whether this effect is persistent and dose dependent. Forty-eight New Zealand White rabbits underwent endothelial denudation of the abdominal aorta using a Fogarty balloon catheter. Test rabbits were given low-dose (2 mg) or high-dose (8 mg) doxazosin daily and all animals killed at either 1 or 12 weeks after the procedure. The aortas were harvested after fixation in situ with 4 per cent glutaraldehyde and neointimal hyperplasia was measured, using an x-y digitizer, as the percentage reduction in luminal cross-sectional area. At I week after surgery, rabbits receiving the low dose had a median area reduction of 7.7 per cent and those receiving the high dose a reduction of 8.2 per cent; both had significantly less intimal hyperplasia than control rabbits, which had a median area reduction of 14.8 per cent (P &lt; 0.01). However, at 12 weeks, when compared with the 32.6 per cent reduction in the control group, only those rabbits receiving high-dose doxazosin had significantly less intimal hyperplasia, with a reduction of 5.5 per cent (P &lt; 0.001). It is concluded that selective α1-adrenergic blockade significantly reduces neointimal hyperplasia, that this effect is dose dependent, and that it persists for at least 3 months.
Circadian variation in unexpected postoperative death
Authors: Rosenberg J , Pedersen M H , Ramsing T , Kehlet H 
Published: March 2007

Abstract
Unexpected deaths still occur following major surgical procedures. The cause is often unknown but may be cardiac or thromboembolic in nature. Postoperative ischaemia, infarction and sudden cardiac death may be triggered by episodic or constant arterial hypoxaemia, which increases during the night. This study examined the circadian variation of sudden unexpected death following abdominal surgery between 1985 and 1989 inclusive. Deaths were divided into those occurring during the day (08.00–16.00 hours), evening (16.00–24.00 hours) and night (24.00–08.00 hours). Twenty-three deaths were considered to have been totally unexpected. Of 16 such patients undergoing autopsy, pulmonary embolism was the cause of death in five. In the remaining 11 patients, death occurred at night in eight (P &lt; 0.005). Five of the seven patients without an autopsy died at night (P &lt; 0.04); overall, 13 of 18 unexpected deaths occurred at night-time. These results suggest a need for further studies of sleep-and respiration-related effects on postoperative nocturnal cardiac function. The efficacy of monitoring during this apparent high-risk period should be evaluated.
Traumatic amputation by explosive blast: Pattern of injury in survivors
Authors: Hull J B 
Published: March 2007

Abstract
Explosive blast causes a pattern of injury including primary blast lung, secondary fragment injury and traumatic amputation of limbs. Major traumatic amputation is rare in survivors of bomb blast but common in those who die. The mechanism of such injury has not been previously determined, but must be established if protective measures are to be developed for members of the armed forces. The nature of 41 traumatic amputations in 29 servicemen who survived to reach medical care after blast injury was investigated to determine the anatomical level of amputation and the pattern of soft tissue damage. Joints were an infrequent site of amputation and the tibial tuberosity was a particularly frequent site of lower-limb severance. Comparison of the pattern of injury was made with that seen in ejecting fast-jet pilots, who frequently suffer major flailing injury; there appears to be a substantially different injury distribution. The accepted mechanism of traumatic amputation, avulsion by the dynamic overpressure, is challenged: it is suggested that the shockwave resulting from an explosion is capable of causing at least bone disruption in a limb.
Oesophageal cancer: A population-based study of survival after treatment
Authors: Oliver S E , Robertson C S , Logan R F A 
Published: March 2007

Abstract
The survival of patients with oesophageal cancer diagnosed during the period 1982–1985 in Nottingham has been studied. Of 496 patients identified from endoscopy, histopathology and hospital activity analysis records, 268 (171 men) lived in the catchment area and had primary oesophageal cancer. Compared with previous studies the proportion of adenocarcinoma (35 per cent) was twice that expected, although survival was similar (hazard rate ratio at 2 years 1.0 (95 per cent confidence interval (c.i.) 0.8–1.4)) whether a squamous cell carcinoma or adenocarcinoma was present. Based on the original treatment intention, surgery was attempted in 34 per cent of cases and was associated with a median survival from diagnosis of 293 (95 per cent c.i. 232–367) days, with 41, 19 and 11 per cent surviving 1, 2 and 3 years respectively. Rudical radiotherapy was attempted in 13 per cent of patients and was associated with a median survival of 190 (95 per cent c.i. 136–253) days, with 14, 6 and 6 per cent surviving 1, 2 and 3 years. Intubation alone was performed in 40 per cent of patients, of whom 44 per cent were aged over 75 years and 29 per cent had evidence of metastases, compared with 13 and 11 per cent respectively of those undergoing surgery or radical radiotherapy. The median survival for intubation alone was 100 (95 per cent c.i. 81–122) days, with 6, 3 and 0 per cent of patients surviving 1, 2 and 3 years respectively. Although patients treated surgically had the longest survival, these data indicate that overall survival after any active intervention is modest. Intubation alone is a reasonable option in those not suitable for surgery; randomized trials are needed to compare intubation with new methods of palliation.
Prospective study in adults of splenic preservation after traumatic rupture
Authors: Schweizer W , Böhlen L , Dennison A , Blumgart L H 
Published: March 2007

Abstract
Seventy-five adults with splenic injury were evaluated prospectively over 45 months to examine the possibility of splenic preservation. Haemodynamically unstable patients underwent surgery with the intent of splenic preservation. Stable patients received on-operative treatment regardless of the grade of splenic injury determined by ultrasonography and computed tomography. Thirty-seven patients required splenectomy and in 38 the organ was preserved (20 operative preservation, 18 non-operative treatment). Of 22 patients initially receiving non-operative treatment, there were four secondary haemorrhages after 7, 7, 10 and 13 days making surgery necessary. Three of these patients underwent splenectomy and in one the spleen was preserved by partial resection. After splenectomy four patients required reoperation because of rebleeding or for evacuation of a haematoma. Patients who had undergone splenectomy had a significantly increased infection rate (P &lt; 0.005) compared with those in whom the spleen was preserved, even when patients were matched with respect to multiple trauma using the Injury Severity Score (P &lt; 0.01).
Endoscopic management of postoperative bile leaks
Authors: Mortensen J , Kruse A 
Published: March 2007

Abstract
Thirty-two patients aged 15-89 years developed postoperative bile leakage. Twenty-eight had undergone cholecystectomy, with choledocholithotomy in 11, and four had had miscellaneous operations. Endoscopic retrograde cholangiopancreatography (ERCP) was performed 2–75 days after operation and revealed leakage from the cystic duct stump in 19 cases, from a T tube track in five, from the gallbladder and liver abscess cavity in two and from the major bile ducts in six. Major bile duct lesions were not generally amenable to endoscopic treatment, but the remaining 26 patients were treated successfully with internal stenting (22) or endoscopic sphincterotomy (four); bile secretion in all cases stopped within I week. One patient with cholangitis after an ERCP procedure was managed by antibiotics; no other complication occurred and there were no deaths related to the procedure. ERCP procedures are well tolerated in the postoperative period and may be performed under sedation. ERCP is the method of choice for dealing with bile leakage and ERCP procedures are effective for the most common causes of postoperative bile leakage; complications are rare.
Role of endoscopic retrograde cholangiopancreatography in the investigation of pain after cholecystectomy
Authors: Carlson G L , Rhodes M , Stock S , Lendrum R , Lavelle M I , Venables C W 
Published: March 2007

Abstract
Patients who continue to have or who develop abdominal pain after apparently successful cholecystectomy pose diagnostic difficulties. This study reports 384 such patients, investigated by endoscopic retrograde cholangiopancreatography (ERCP). There were 146 patients with abdominal pain alone with no previous history of common bile duct (CBD) exploration, of whom only 17 (11.6 per cent) had CBD stones on ERCP. Bile duct calculi were present in 76 of 140 patients (54.3 per cent) with abnormal biochemical findings (raised alkaline phosphatase and/or amylase level) and in 34 of 57 (60 per cent) with an abnormality detected on ultrasonography or intravenous cholangiography. A combination of biochemical and radiological abnormalities was present in 37 patients and was associated with CBD stones in 28 (76 per cent). Patients who had undergone CBD exploration represented a special group, of whom the majority (75 per cent) had common duct stones at ERCP even in the absence of biochemical and radiological abnormalities. ERCP is a useful investigation in patients with persistent postcholecystectomy symptoms. Other features in addition to pain or a history of CBD exploration may be relevant to the decision to perform ERCP in the investigation of these patients.
Common bile duct diameter and complications of endoscopic sphincterotomy
Authors: Wilson M S , Tweedle D E F , Martin D F 
Published: March 2007

Abstract
To assess the relationship between distal common bile duct (CBD) diameter and the incidence of an immediate complication following endoscopic sphincterotomy (ES), all patients undergoing ES between January 1986 and October 1990 were studied. The overall risk of an immediate complication following ES in 655 patients was 5.6 per cent (37 patients). Patients with calculi were at greater risk if the distal CBD was dilated (P &lt;0.001); the complication in those with stones was most likely to be haemorrhage (81 per cent). The relative risk of a complication increased ten times if the distal bile duct diameter was &gt;0.8 cm. Patients with stricture of the distal CBD did not have a significantly greater risk of complication than those with stones (9.7 versus 4.9 per cent). There was no significant difference between the mean distal CBD diameter of those with stricture and controls (0.61 versus 0.44 cm).
Psychological screening for non-specific abdominal pain
Authors: Fraser S C A , Smith K , Agarwal M , Bates T 
Published: March 2007

Abstract
Non-specific abdominal pain (NSAP) may have a detectable psychological component that could be used to predict outcome. To test this hypothesis, 131 patients aged 14–40 years admitted with acute abdominal pain were assessed using the General Health Questionnaire (GHQ) and Hospital Anxiety and Depression (HAD) scale, and a structured interview. Of 61 patients with NSAP, more had a psychosocial problem identified by the admitting registrar (P &lt; 0.01) and marginally more had high questionnaire scores. The risk of having NSAP was high if an abnormality on interview accompanied high questionnaire scores (relative risk 1.93 (95 per cent confidence interval (c.i.) 1.35–2.77)) or if prodromal pain had lasted &gt; 7 days (relative risk 2.13 (95 per cent c.i. 1.55–2.92)). After 2 years, patients with continuing pain had higher HAD and Spielberger Anxiety Trait scores (both P &lt; 0.02); NSAP was associated with persisting pain (relative risk 2.22 (95 per cent c.i. 1.10–4.48)). Psychosocial factors are implicated in NSAP and in chronic pain, but the sensitivity and specificity of questionnaire assessment are too low to be useful in diagnosis.
Anovaginal and rectovaginal fistula in patients with Crohn's disease
Authors: Scott N A , Nair A , Hughes L E 
Published: March 2007

Abstract
Between 1971 and 1991, details of 67 women with perianal Crohn's disease were recorded prospectively using the Cardiff classification. Two groups were identified according to the presence (n = 29) or absence (n = 38) of anorectal Crohn's fistula involving the vagina. Patients in both groups were of a similar age and had had Crohn's disease for a similar period before diagnosis of perianal involvement. The incidence of associated perianal lesions, superficial ulcers, cavitating ulcers, other fistulas and strictures was not significantly different between the two groups. A greater proportion of patients with anorectal-vaginal fistulation (n = 15) had distal intestinal Crohn's disease (rectal or contiguous colorectal) compared with women with no vaginal fistulation (n = 14). A range of therapies was used to manage women with perianal Crohn's disease, from local surgery to a defunctioning stoma and/or proctectomy. Only 13 of 38 women with perianal Crohn's disease but no vaginal fistula required a defunctioning stoma or proctectomy, whereas 18 of 29 with anorectal-vaginal fistulation underwent these procedures (P ≤ 0.05). A vaginal fistula has a considerable adverse effect on the outcome of perianal Crohn's disease.
Manual dilatation of the anus
Authors: Macdonald A , Smith A , McNeill A D , Finlay I G 
Published: March 2007

Abstract
A group of 100 consecutive patients undergoing manual dilatation of the anus between 1980 and 1983 were reviewed retrospectively by examining the clinical presentation, diagnosis, treatment and outcome. Anal fissure was diagnosed in 46 patients, 22 had either first-or second-degree haemorrhoids, and stenosis of the anal canal was identified in seven. Manual dilatation of the anus was performed on 25 patients in the absence of a diagnosis. Dilatation failed to treat 26 anal fissures successfully. Where it was employed alone in ten cases of haemorrhoids and seven of anal stenosis, manual dilatation failed to cure seven and five patients respectively. Of the patients with no diagnosis, 23 were relieved of their symptoms following dilatation. Episodes of incontinence occurred in 27 patients, 21 of whom were female. There should be a reduced role for manual anal dilatation in the treatment of common anorectal disorders.
Medullary thyroid carcinoma
Authors: Dunn J M , Farndon J R 
Published: March 2007

Abstract
Medullary thyroid carcinoma accounts for 5–10 per cent of thyroid malignancies and occurs sporadically, and in three familial settings with autosomal dominant inheritance. Calcitonin, a 32 amino acid 3.5-kDa protein, is a biochemical marker of the tumour. Serum levels correlate with disease burden. Treatment initiated by screening allows disease removal at a premalignant phase: C cell hyperplasia. Genetic linkage studies locate the multiple endocrine neoplasia type 2A gene near the centromere of chromosome 10. Flanking genetic markers may allow polymorphic probes to examine DNA from a once-only blood sample to identify affected individuals. At what age thyroidectomy should be carried out in these patients is unclear.
Contemporary management of the appendiceal mass
Authors: Nitecki S , Assalia A , Schein M 
Published: March 2007

Abstract
An appendiceal mass is the end result of a walled-off appendiceal perforation and represents a pathological spectrum ranging from phlegmon to abscess. Over the past decade, improved imaging and interventional radiological techniques have allowed a more accurate definition of pathology and thus a more specific and less invasive management than was previously possible. A management policy should be possible that allows over 80 per cent of patients presenting with an appendiceal mass to be safely spared an open operation.
Autotransfusion in aortic surgery: The Haemocell System 350 cell saver
Authors: Kalra M , Beech M J , Al-Khaffaf H , Charlesworth D 
Published: March 2007

Abstract
Autotransfusion was performed during elective abdominal aortic reconstruction in ten patients using the recently developed Haemocell System 350. A mean of 60 per cent of total blood loss was salvaged, and during operation each patient was autotransfused 1 unit. Good preservation of cellular components, including platelets, was seen after processing with the device, which uses a vortex mixing filter for cell separation. There was no evidence of coagulopathy; mean free plasma haemoglobin levels were slightly raised (17 mg/dl) and plasma heparin concentration was negligible (0·10 units/ml) 4 h after surgery. A transient drop in plasma fibrinogen levels and the appearance of fibrin degradation products in low concentrations (mean 1·5 mg/l) were seen. Oxyhaemoglobin dissociation curves showed the salvaged red blood cells to have a normal affinity for oxygen. Renal and hepatic function remained unaltered and there were no complications attributable to autotransfusion. The device was easy to handle and a trained operator was not required.
Transit disorders of the gastric remnant and Roux limb after Roux-en-Y gastrojejunostomy: Relation to symptomatology and vagotomy
Authors: van der Mijle H C J , Beekhuis H , Bleichrodt R P , Kleibeuker J H 
Published: March 2007

Abstract
Patients after Roux-en-Y gastrojejunostomy frequently complain of upper abdominal pain, fullness, nausea and vomiting. This study was performed to clarify the relationship of this Roux-en-Y syndrome to transit disorders in the gastric remnant and Roux limb, and to vagal status. Using a questionnaire, 35 of 66 patients operated on between 1976 and 1987 were judged to suffer from the Roux syndrome. Gastrojejunal transit was studied by scintigraphy with a solid test meal in 61 patients, 34 of whom were symptomatic. The median (interquartile range) gastric half-emptying time was longer in symptomatic than in asymptomatic patients (79 (43–146) versus 56(27–79) min, P &lt; 0·05), and in patients with a bilateral vagotomy than in those without a vagotomy (94 (43–225) versus 59 (31–77) min, P &lt; 0·05). Stasis in the Roux limb was observed in 18 of 28 symptomatic and in only three of 27 asymptomatic patients (P &lt; 0·01). The median (interquartile range) fraction of activity emptied from the stomach and remaining in the Roux limb at 60 min was 54 (39–60) per cent in symptomatic patients and 33 (21–40)per cent in those without symptoms (P &lt; 0·01). Stasis in the Roux limb was not related to vagal status. No relationship between slow gastric emptying and Roux-limb stasis was found. Slow gastric emptying, Roux-limb stasis or a combination of both was found in 30 of 34 symptomatic and in only nine of 27 asymptomatic patients (P &lt; 0·01). It is concluded that both slow gastric emptying and Roux-limb stasis can be interpreted as causing the Roux syndrome. Vagotomy seems to be the major cause of slow gastric emptying, but it is not related to stasis in the Roux limb.
Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis
Authors: Neoptolemos J P , London N J M , Carr-Locke D L 
Published: March 2007

Abstract
The integrity of the main pancreatic duct (MPD) was evaluated by endoscopic retrograde pancreatography (ERP) in a retrospective study of 105 patients with acute pancreatitis presenting over an 11-year period (1980–1991). The findings were compared with clinical outcome and the need to operate for local pancreatic complications. Patients were divided into two groups. Group 1 (n = 89) had either clinically mild pancreatitis or severe disease but no surgery for local complications, and &lt;25 per cent necrosis on contrast-enhanced computed tomography (CT) (n = 48). Group 2 patients (n = 16) had clinically severe pancreatitis and underwent surgery for local complications and/or had ≧ 25 per cent necrosis on CT (n = 12), at surgery or post mortem. All 89 patients in group 1 had an intact MPD at ERP, which was performed a median of 6 (range 0–30) days after onset of pancreatitis; the median age was 63 (range 20–88) years and there were no deaths. The median age of patients in group 2 was 59 (range 26–85) years. ERP in this group was performed in four patients &lt;5 days after onset and all had an intact MPD; one died with necrosis and another from a cerebrovascular accident. ERP was performed ≧ 5 days after onset in the other 12 patients: five had an intact MPD and two required surgery for pseudocyst drainage only; seven had a disrupted MPD and all required surgery for pancreatic necrosis (one death). It is concluded that an intact MPD was a feature of mild pancreatitis, whereas disruption occurred &gt;4 days after onset in patients with necrosis necessitating surgery.