bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resting energy expenditure in the critically ill: Estimations versus measurement
Authors: Hunter D C , Jaksic T , Lewis D , Benotti P N , Blackburn G L , Bistrian B R 
Published: March 2007

Abstract
A prospective trial was conducted in 20 surgical intensive care unit patients receiving mechanical ventilation to compare estimates of resting energy expenditure (REE) with the measured values. The 12 women and 8 men (mean age 61·7±2·8 (s.e.m.) years) underwent a full nutritional assessment before measurement of their REE by indirect calorimetry using the MGM II metabolic cart (Utah Medical). Their REE was estimated by the Harris-Benedict formula (mean 1324±53 (s.e.m.) kcal/day) as well as an empirical formula (where empirical formula = 22 × body weight in kg) (1370 ± 68 (s.e.m.) kcal/day). Results by either estimate were not statistically different from the measured resting energy expenditure (MREE) (1382±130 (s.e.m.) kcal/day), by one-way analysis of variance. No multiplication factors were needed to relate the Harris–-Benedict formula to MREE in this critically ill population and the estimate by the empirical formula was as good and simpler to perform. Although values by the Harris—Benedict formula and empirical formula correlated significantly with MREE (P &lt; 0·05) the correlation coefficients were low: 0·48 and 0·45 respectively. Thus, mean estimates were excellent for the group but less predictive for the individual. Multiple linear regressions did reveal that body composition and metabolic stress were of greater predictive value, since an equation relating weight (P &lt;0·003), sex (P &lt;0·003), white blood cell count (P &lt; 0·003) and 24-h urinary creatinine excretion (P &lt; 0·05) could predict 76 per cent of the variation (r = 0·87) in the MREE with an overall significance of P = 0·0002. Given the importance of matching energy intake to needs in many critically ill patients who are mechanically ventilated, accurate measurement of the REE is recommended now that instrumentation is equal to the task.
Grip strength: A measure of the proportion of protein loss in surgical patients
Authors: Windsor J A , Hill G L 
Published: March 2007

Abstract
Measurements of voluntary hand grip strength (GS) are a sensitive predictor of postoperative complications. The loss of body protein is thought to be important in the development of these postoperative complications, but the relationship between GS and body protein status has not been studied. We have measured GS (by hand dynamometry), total body protein (indirectly by mid-arm muscle circumference, and directly by in vivo neutron activation analysis) and the proportion of protein loss (protein index) in 80 patients with gastrointestinal disease and 87 normal volunteers. Using regression analysis, a matched study and clinical decision analysis, it has been demonstrated that GS is a sensitive measurement of the degree of protein loss. The results support more widespread use of GS measurements in the identification of patients at high risk of postoperative complications and in the monitoring of patient response to nutritional intervention.
Choledochal cyst: A 14-year surgical experience with 36 patients
Authors: Tan K C , Howard E R 
Published: March 2007

Abstract
The presentation and management of 36 patients with cystic dilatation of the biliary tree seen over a 14-year period is reviewed. There were 28 females and 8 males, a ratio of 3·5:1. The classic triad of jaundice, pain and an abdominal mass was seen in only seven cases. Twelve patients suffered recurrent pancreatitis. There were three cases of variceal haemorrhage from portal hypertension secondary to biliary cirrhosis, and one case of biliary peritonitis from a ruptured cyst. Internal drainage (cystenterostomy) was performed in nine patients but five of these eventually needed cyst excision. Cysts have been excised primarily in the last 21 consecutive patients without mortality. Preliminary external drainage with T tubes was used before cyst resection in three patients who presented with complications of choledochal cysts. Cyst excision and hepaticojejunostomy is now the definitive treatment of choice.
New technique of anastomosis after resection of left colon and rectum
Authors: Korepanov V I , Sh. Chuntua R , Sugrobov S P 
Published: March 2007

Abstract
A novel technique of ‘autorecanalizing’ anastomosis has been developed experimentally to reduce the risk of anastomotic failure when resection of the left colon or rectum is performed in the face of suboptimal bowel preparation. The method has been used in nine patients who presented with large bowel obstruction. One patient developed a low output faecal fistula that closed spontaneously within 19 days of operation. No leakage was detected in the remaining eight patients. The delay between operation and recanalization ranged from 8–13 days and the caecostomy used for intubation closed spontaneously within 24 days of surgery.
Diagnosis and management of graft—enteric fistulae
Authors: Tilanus H W , Terpstra O T , de Smit P , van Urk H , Veen H F 
Published: March 2007

Abstract
During a 7-year period 20 patients underwent operation for a graft-enteric fistula after implantation of an intra-abdominal vascular prosthesis months or years before. Eighteen patients had gastrointestinal blood loss as their first symptom; 12 were in shock on admission. Fourteen patients had a fistula between the proximal anastomosis and the duodenum. Graft excision followed by axillobifemoral bypass was performed in 10 patients and four patients underwent local repair. A fistula between the distal anastomosis and the bowel was found in the remaining six patients and a local repair was carried out. Proximal graft-enteric fistula carries a particularly high postoperative mortality rate of more than 50 per cent.
Cholecystokinin (CCK) provocation test: Long-term follow-up after cholecystectomy
Authors: Rhodes M , Lennard T W J , Farndon J R , Taylor R M R 
Published: March 2007

Abstract
Over a 6-year period 264 cholecystokinin (CCK) provocation tests have been performed in 174 patients with undiagnosed right upper quadrant pain. All were carried out by one person (T.W.J.L.) as part of a prospective placebo-controlled crossover study. Following infusion of CCK but not saline, 103 patients developed pain (CCK + ve). These patients were offered cholecystectomy and 90 accepted. Seventy patients developed no pain during either infusion (CCK − ve), and one patient experienced pain with both CCK and saline infusions. Of the 90 patients who underwent cholecystectomy, 81 (90 per cent) have been followed up for a mean of 35 months (range 12 months to 5½ years), 67 percent have had complete resolution of symptoms and a further 24 percent have had a marked improvement in symptoms. Only 9 per cent of patients did not benefit from cholecystectomy. This compares well with patients undergoing cholecystectomy for uncomplicated calculous gallbladder disease, 88 per cent of whom, in our study, were improved by surgery. Patients with a positive CCK test have an excellent chance of symptomatic improvement following cholecystectomy.
ERCP findings and the role of endoscopic sphincterotomy in acute gallstone pancreatitis
Authors: Neoptolemos J P , Carr-Locke D L , London N , Bailey I , Fossard D P 
Published: March 2007

AbstractA total of 131 patients with acute pancreatitis (of whom 100 had gallstones) underwent endoscopic retrograde cholangiopancreatography (ERCP) during the same hospital admission. Urgent ERCP (&lt;72 h) was performed in 68 cases and early ERCP (3–30 days) in 63 cases; 47 had predicted severe attacks and 84 had predicted mild attacks (modified Glasgow criteria). The highest incidence of common bile duct stones occurred in those with predicted severe attacks and those who had urgent ERCP. Highly significant correlations were found between age and common bile duct and pancreatic duct diameters. Significant correlations were also found between the common bile duct and pancreatic duct (correcting for age) and between these and the admission serum bilirubin. The common bile duct diameter was greatest in those with common bile duct stones and predicted severe attacks. A considerably lower incidence of pancreatic duct filling occurred in those with predicted severe attacks and common bile duct stones; in predicted mild attacks the pancreatic duct diameter was greater in those with common bile duct stones. In gallstone patients complications were highest in those with predicted severe attacks but more significantly in those with common bile duct stones. Endoscopic sphincterotomy was undertaken in 37 patients with common bile duct stones without mortality. The overall complication rate in gallstone patients was 19 per cent and the mortality rate was 2 per cent. These findings suggest that common bile duct stones cause acute common bile duct and pancreatic duct obstruction and are closely associated with complications. Urgent ERCP for detection of common bile duct stones, and endoscopic sphincterotomy for treatment, is strongly recommended for patients with predicted severe attacks due to gallstones and should also be considered for others who fail to show clinical improvement.
A prospective comparison of the effects of placebo, ranitidine and highly selective vagotomy on 24 h ambulatory intragastric pH in patients with duodenal ulcer
Authors: Rogers M J , Holmfield J H M , Primrose J N , Gledhill T , Johnston D 
Published: March 2007

Abstract
Twenty-four hour ambulatory intragastric pH (24 h IGpH) recording, a highly reproducible technique, was used to compare the effects of ranitidine and highly selective vagotomy (HSV) in 20 patients who had been referred for surgical treatment of duodenal ulcer. The 24 h IGpH was recorded when they were taking either placebo or ranitidine 300 mg at 10 pm, and again 4 to 13 weeks after elective HSV. Median 24 h IGpH and 24 h hydrogen ion activity (24 h [H+]) were calculated for each patient. Median (quartile) 24 h IGpH was 1.4 (1.3–1.6) with placebo, 2.2 (1.8–2.7) after ranitidine and 2.6 (1.8–3.7) after HSV. IGpH was significantly higher after both ranitidine (P &lt; 0.0001) than after placebo, but IGpH after ranitidine did not differ from IGpH after HSV (0.5 &gt; P &gt; 0.4). HSV reduced 24h [H+] by a median 68 per cent (quartiles, 47–82 per cent) whereas ranitidine reduced it by only 50 per cent (34–69 per cent, 0.1 &gt; P &gt; 0.05). The 24h pH recording was then analysed as two distinct periods; ‘daytime’ (8 am to midnight) and ‘night-time’ (midnight to 8 am). HSV reduced night-time [H+] by a median 77 per cent (59–93 per cent) whereas ranitidine reduced it by only 30 per cent (13–45 per cent, P &lt; 0.0001). HSV reduced daytime [H+] by a median 57 per cent (40–83 per cent) but ranitidine reduced it by a median 92 per cent (78–98 per cent, P &lt; 0.01). Thus, HSV inhibits gastric acidity more during the day than at night, whereas raniditine given at 10 pm effectively suppresses night-time acidity but is much less effective in suppressing daytime acidity. However both HSV and ranitidine will heal more than 90 per cent of duodenal ulcers. Hence, contrary to Dragstedt's teaching, suppression of nocturnal acidity is not of crucial importance for the healing of duodenal ulcers.
Testicular torsion in Bristol: A 25-year review
Authors: Anderson J B , Williamson R C N 
Published: March 2007

Abstract
To identify changes in incidence, presentation, management and outcome, 670 patients with torsion of the spermatic cord presenting in Bristol between 1960 and 1984 have been reviewed. Among the susceptible population of 150000, the annual incidence of torsion has increased fourfold from 11.2 cases between 1960 and 1964 to 42.8 cases between 1980 and 1984. Throughout this period &gt; 90 per cent of patients have been managed by general surgeons. Patients aged between 12–18 years comprised 62 per cent but 20 per cent were 21 years or older. Torsion was commoner in the cold months, 24 per cent of cases occurring during December and January (χ2 = 30.26, P &lt; 0.01). When acute torsion was relieved within 12 h of the onset of symptoms only 4 per cent of affected testes were considered non-viable, but beyond this time 75 per cent of patients received orchidectomy. Overall, 238 of 624 (38 per cent) acutely twisted testes were found to be infarcted at operation, and a further 35 patients (6 per cent) had marked testicutar atrophy on review 3 months later. The testicular salvage rate has steadily improved from 45 per cent in the years 1960–64 to 67 per cent in 1980–84. Much of the increased incidence of testicular torsion is likely to reflect a greater awareness of the condition by general practitioners. It has been more than matched by an improvement in testicular salvage rate because of earlier referral.
Intra-operative inflow resistance measurement: A predictor of steal syndromes following femoro-femoral bypass grafting
Authors: Nicholson M L , Beard J D , Horrocks M 
Published: March 2007

Abstract
Although femorofemoral bypass grafting was originally used only as a method of limb salvage, it is now used increasingly in patients with claudication. If this trend is to be supported, the haemodynamic consequences of the operation must be carefully assessed. Fifteen patients undergoing femorofemoral grafting were studied prospectively by intra-operative measurement of the inflow resistance (IR) of the donor iliac segment. Three groups were identified by this technique. Patients with an IR&lt;0.05 (n = 8) were uncomplicated; those with an IR ⩾0.05 but &lt;0.10 (n = 5) developed a subclinical steal syndrome; and those with an IR &gt;0.10 (n = 2) developed a clinical steal syndrome. High initial IR values were corrected at the time of surgery in two cases. This study demonstrates that steal syndromes can occur after femorofemoral grafting and that the cause is an unmasking of previously unrecognized disease in the donor arterial segment. The measurement of IR allows the prediction of steal syndromes and their correction at the time of surgery. Direct haemodynamic studies are recommended, especially as the availability of balloon angioplasty has made inflow disease amenable to treatment.
Natural history of the benign breast lump
Authors: Sainsbury J R C , Nicholson S , Needham G K , Wadehra V , Farndon J R 
Published: March 2007

Abstract
A prospective study of 112 patients with clinically discrete benign breast lumps has shown that 68 per cent of patients experienced resolution of their lumps over a period of up to 2 years. Resolution of both fibro-adenomas and discrete areas of fibro-adenosis was observed. Diagnosis was achieved by clinical examination and fine needle aspiration cytology. Four patients thought clinically to have benign disease were proven by cytology to have a carcinoma, but no patient with a cytopathological diagnosis of benign disease has developed cancer during or subsequent to this study. We recommend that patients under 35 years of age with clinically and cytologically benign breast lumps can be offered the option of non-excision in the reasonable expectation of resolution of their lesion.
Increase in pudendal nerve terminal motor latency with defaecation straining
Authors: Lubowski D Z , Swash M , Nicholls R J , Henry M M 
Published: March 2007

Abstract
The relationship between perineal descent and pudendal nerve damage was tested in 57 consecutive patients by measuring the left and right pudendal nerve terminal motor latency (PNTML) before and after a maximal defaecation straining effort. In 13 patients the PNTML was also measured 1 and 4 min later. The difference between the mean PNTML before and after straining (ΔPNTML) was correlated with the amount of descent (r = 0.40, P&lt;0.005), and with the perineal position during straining (r = −0.46, P&lt;0.001). Four minutes after the straining effort the PNTML again approached the resting value in each subject. These findings support the concept that perineal descent causes pudendal nerve damage.
Use of staplers on oesophagogastric varices
Authors: Cai Cheng-Ji , Wang Cheng-Pei 
Published: March 2007

Abstract
Thirty-five gastrofundic devascularization procedures were performed with the side-to-side CF stapler of Chinese manufacture for obliteration of oesophagogastric varices. Four patients were operated on as emergencies, six patients 2–3 weeks after control of bleeding by tamponade and the remaining twenty-five electively (including four patients who had not bled). There were two operative deaths, an operative mortality of 6 per cent. In all, 30 patients have been followed, 20 for 1–3 years and 10 for less than 1 year. Twenty-five patients had postoperative barium meal examination. The varices were ameliorated in 19, not changed in 5 and exacerbated in 1. Nine patients rebled and of these, two died. The stapler is used in devascularization to interrupt intramural varices in the oesophagocardiac region. It must be emphasized that its use is only a part of the devascularization procedure. When used alone devascularization is not complete. The side-to-side stapler appears to be a convenient, safe and rational instrument for use in devascularization.
Adjuvant treatments following curative resection for gastric cancer
Authors:   The Italian Gastrointestinal Tumor Study Group, Bonfanti G 
Published: March 2007

Abstract
The results of a prospective randomized trial of adjuvant treatment after curative resection for gastric cancer are reported. The study consisted of three arms: (1) surgery only; (2) chemotherapy (5-fluoro-uracil (FU) and 1-(2-chloroethyl)-3-(4-methylcyclohexil)-1-nitrosourea (Me-CCNU)) after surgery; (3) chemo-immunotherapy (FU, Me-CCNU and levamisole) after surgery. Between March 1977 and June 1981, 235 patients were included in the study by 18 co-operating institutions. Thirteen per cent of patients in arm 2 and thirteen per cent in arm 3 suffered major toxicity, necessitating interruption of treatment. Two of these patients died of marrow aplasia. Statistical analysis of survival showed that prognosis was influenced by the well-known prognostic variables, invasion of the wall, nodal status and site of tumour. The different treatments in the three arms, however, did not show any impact on prognosis, even when adjustments were made for the most relevant prognostic variables. Given the lack of effect on survival and the presence of clinically important toxicity, FU and Me-CCNU ± levamisole cannot be recommended as adjuvant therapy for resected gastric cancer.
Death from undiagnosed peptic ulcer complications: A continuing challenge
Authors: Armstrong C P , Whitelaw S 
Published: March 2007

Abstract
A 10-year study of all 9653 autopsies performed in the Plymouth Health District, UK from 1977 to 1986 revealed 154 patients who died from undiagnosed peptic ulcer complications. In all, 118 of these patients died suddenly at home and 36 died in hospital. Most patients were elderly although 47 were under 70 years and 2 were under 50 years of age. Anti-inflammatory drugs were being used by 81 of these patients, an incidence of 60 per cent where full drug histories were available. Women who died were much more likely to be using these drugs than men. This study emphasizes the hitherto unrecognized importance of death from undiagnosed peptic ulcer disease and further highlights the potential risk of non-steroidal anti-inflammatory drug use.
Multivariate approach for assessing the prognosis of clinical oesophageal carcinoma
Authors: Sugimachi K , Matsuoka H , Ohno S , Mori M , Kuwano H 
Published: March 2007

Abstract
We investigated the prognostic contribution of 15 discrete variables on the survival of 123 patients with carcinoma of the oesophagus who underwent oesophagectomy and oesophageal reconstruction. In the mulitvariate analysis, three of fifteen variables were associated with the prognosis of patients who underwent oesophagectomy. The variables are: resectability of the malignant lesion, DNA distribution pattern of the cancer cells and postoperative complications. The DNA distribution pattern proved to be one of the most reliable prognostic factors. These three variables were assigned one of two values, ‘favourable’ or ‘unfavourable’, indicative of the effect on survival. The 123 patients were classified into four groups, characterized by eight possible combinations of these three variables. The survival rate of those with two or more ‘favourable’ variables was the highest, that is about 50 per cent at 5 years after surgery. On the other hand, patients with two or more ‘unfavourable’ variables had a very poor prognosis. Therefore, early detection and postoperative care play key roles in determining the survival of patients with oesophageal carcinoma.
Management of severe intra-abdominal sepsis: Single agent antibiotic therapy with cefotetan versus combination therapy with ampicillin, gentamicin and metronidazole
Authors: Huizinga W K J , Baker L W , Kadwa H , van den Ende J , Francis A J , Francis G M 
Published: March 2007

Abstract
In a prospective, randomized trial involving 100 patients with severe intra-abdominal sepsis, the value of single agent antibiotic therapy with cefotetan was compared with that of combination therapy of ampicillin, gentamicin and metronidazole (AGM). All patients underwent exploratory laparotomy. The mortality rate was 3 per cent, all deaths occurring within 48 h of operation. Two-thirds of patients were considered severely ill on admission, and one-third were moderately ill. Six patients had positive blood cultures on entry into the study. The mean age was 31 years and concurrent disease was present in 14 percent of the patients. A satisfactory response was achieved in 82 per cent of patients receiving cefotetan and in 65 per cent of those receiving AGM, whereas the response was unsatisfactory in 18 per cent of cefotetan patients and 35 per cent of those receiving AGM (P = 0.075 n.s.). Significant changes in laboratory values during the study occurred in 51 per cent of patients, and 7 per cent required vitamin K administration for hypoprothrombinaemia. The results of this study suggest that antibiotic therapy with single agent cefotetan is as safe and effective as a combination of ampicillin, gentamicin and metronidazole in patients with severe intra-abdominal sepsis requiring operative management.
Splenic repair for trauma
Authors: Ghosh S , Symes J M , Walsh T H 
Published: March 2007

Abstract
The risks of overwhelming post-splenectomy infection (OPSI) are now well documented both in children and adults. Although the incidence of OPSI is comparatively low following splenectomy for trauma, it has a high mortality. Splenectomy is no longer the treatment of choice for splenic injury and splenic salvage is recommended whenever feasible. Since 1982, in the Isle of Wight hospitals, 13 cases of splenic injury following trauma have been treated applying various salvage procedures and are reported here.