bluuebunny/crossref_metadata_2025_split huggingface dataset:
Femorotibial bypass for limb salvage using human umbilical vein
Authors: Klimach O , Charlesworth D 
Published: March 2007

Abstract
A series of 112 consecutive femorotibial bypasses was reviewed in which glutaraldehyde-stabilized human umbilical vein was used for the bypass. The duration of follow-up was between 6 months and 2 1/2 years. Cumulative patency at 2 years for the entire group was 9 per cent. The state of the pedal arteries, site of the distal anastomosis and age of the patient influenced the results. The difference in the patency rates at 1 year between patients with 3 patent pedal arteries and those with only 1 is significant (P &lt; 0·001) as is that between those with 3 and those with 2 (P = 0·024). Of 49 patients with pre-gangrene, in whom the bypass worked for a period in excess of 2 months, only 7 eventually required amputation in contrast to 32 of a group of 39 similar patients in whom the bypass failed early.
Carotid artery surgery in patients with minor stroke
Authors: Takolander R J , Bergentz S-E , Ericsson B F 
Published: March 2007

Abstract
Of 229 carotid artery reconstructions, 67 were performed in patients after a minor stroke. In this group of patients the operative mortality was 5·9 per cent, compared with 1·8 per cent in the group of patients without preoperative minor stroke operated upon during the same period of time. The 5-year survival in the stroke group was 86 per cent and in the non-stroke group it was 65 per cent. Excluding the postoperative mortality, the survival increases to 90 and 68 per cent respectively. The difference, which is significant at 6 years (P &lt; 0·05), is explained by a higher incidence of coronary artery disease in the non-stroke group. The postoperative annual stroke frequency was 2·3 per cent in the stroke group and 2·4 per cent in the non-stroke group. The stroke frequency on the operated side during follow-up was 1·6 per cent per year for both groups together. It seems that a minor stroke is no contraindication to carotid artery reconstruction provided the timing of the operation is correct and other contraindications are considered.
The anal dilator in the conservative management of acute anal fissures
Authors: McDonald P , Driscoll A M , Nicholls R J 
Published: March 2007

Abstract
Patients presenting with acute anal fissure were randomized into two treatment groups in a prospective clinical trial. Both groups received treatment for 3 weeks with a stool softener and lignocaine jelly. Those entered in group 1 (35 patients) were asked in addition to insert an anal dilator (no. 2) twice daily while those in group 2 (31 patients) applied the anaesthetic jelly without a dilator. At 6 weeks 11 (31·4 per cent) patients in group 1 and 12 (38·7 per cent) patients in group 2 had been referred for sphincterotomy owing to failure of the treatment. At 6 months this figure had risen to 14 (40 per cent) in group 1 and 15 (48·4 per cent) in group 2. This difference was not statistically significant, suggesting that the addition of a dilator to the conservative treatment regimen did not diminish the likelihood of surgery.
The grading of sepsis
Authors: Elebute E A , Stoner H B 
Published: March 2007

Abstract
A simple system for grading the severity of sepsis has been developed by scoring the attributes of sepsis under four headings: local effects of infection, pyrexia, secondary effects of sepsis and laboratory data. The information needed should be readily available at district general hospital level. The system produces a number which indicates the severity of sepsis and which varies with the patient's condition. This system could be useful in comparing patients with sepsis and studies on such patients in different centres.
Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses
Authors: Chan S T F , Kapadia C R , Johnson A W , Radcliffe A G , Dudley H A F 
Published: March 2007

Abstract
Intestinal surgery is usually associated with the parenteral administration of sodium and water, sometimes in amounts considerably in excess of excretory capacity. We have studied the effect of this situation on the water content of the gut at and 5 cm from a single-layer end-to-end anastomosis in the rabbit. Water content was measured by desiccation. One group of animals (group 1) did not receive intravenous therapy. The second group (group 2) received 5 ml kg−1 h−1 of Hartmann's solution during the operative period and thereafter to a total volume of 200 ml by 48 h. In group 1 there was a 5–10 per cent increase in tissue weight both at the anastomotic site and at 5 cm (P &lt; 0·01, Mann-Whitney U test) on the first 3 days. Thereafter, water content at the anastomosis persisted, but resolved in normal gut. In group 2 a further 5 per cent increase in weight over group 1 occurred (P &lt; 0·01), persistent at the anastomotic site over 5 days, though resolving elsewhere after 2 days. Extracellular fluid volume expansion exaggerates an anatomical third space present in the region of an anastomosis. At the suture line, oedema so induced is persistent and could be deleterious.
The rectus abdominis myocutaneous island flap in breast cancer
Authors: Webster D J T , Hughes L E 
Published: March 2007

Abstract
The use of 30 rectus abdominis flaps in patients with breast cancer is described. In 7 patients the flap has been used to repair the defect following ablation of recurrent disease or radionecrotic ulcers. In the remaining 23 the flap has been used as part of a primary reconstruction at the time of mastectomy. The technique is described together with the results in these patients. The cosmetic results have been satisfactory. The technique as described has proved completely reliable. Follow-up to 18 months has shown that fears of incisional hernias developing are unfounded.
Dieulafoy's disease: A distinctive arteriovenous malformation causing massive gastric haemorrhage
Authors: McC. Mortensen N J , Mountford R A , Davies J D , Jeans W D 
Published: March 2007

Abstract
Dieulafoy's disease is a distinctive arteriovenous malformation of the gastric fundus, which presents with massive or recurrent gastrointestinal bleeding. The lesion is very small and easily overlooked even at laparotomy, and can only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. A wedge resection will stop bleeding and give histological confirmation of the characteristic submucosal vessels.
The effect of isotonic amino acid infusions on serum proteins and muscle breakdown following surgery
Authors: Garden O J , Smith A , Harris N W S , Shenkin A , Sim A J W , Carter D C 
Published: March 2007

Abstract
Twenty patients undergoing major surgical procedures received constant infusion (2 l/day) of either 3·5 per cent amino acid (AA) or 5 per cent dextrose (D5W) solutions in addition to other fluid requirements for 4 postoperative days. Ketosis was evident in A A patients as a mean daily β-hydroxy butyrate excretion of 2·16 ± 1·39 mmol and respiratory quotient of 0·708 ± 0·013 compared with 0·28 ± 0·45 mmol/day and 0·754 ± 0·015 respectively in the D5W group. The serum total protein and albumin concentrations (but not those of transferrin and prealbumin) were significantly higher in the A A than the D5W group on day 4. However, the mean fluid balance for days 3 and 4 was significantly less positive in AA patients. The mean daily nitrogen balance of −6·6 ± 7·7 gN/day in A A patients and −9·5 ± 5·8 gN/day in D5W patients was not significantly different. Mean daily 3-methyl histidine excretion (38·2 ± 12·3 μmol/mmol creatinine) in A A patients was significantly higher than in D5W patients (31·2 ± 10·8 μmol/mmol creatinine). With no improvement in nitrogen balance, an increase in muscle protein breakdown and the possibility that decreased fluid retention explains the higher serum total protein and albumin levels, this study fails to demonstrate improved protein sparing by isotonic amino acid infusions following surgery.
The action of glucagon and commonly used antispasmodics and analgesics on the canine ureter
Authors: Stower M J , Wright J W , Hardcastle J D 
Published: March 2007

Abstract
Ureteric peristalsis has been studied using extraluminal bipolar electrodes and metal foil strain gauges in both the unanaesthetized and anaesthetized dog. Electrical activity of the ureter was characterized by bipolar action potentials, which always preceded mechanical activity. In the acute studies glucagon 44 μg/kg i.v. was given during the unstimulated phase and again during a forced diuresis. Complete inhibition of ureteric activity was seen for 19·50 (± 3·76 s.e.) and 16·25 (± 1·59 s.e.) min respectively. During this period there was no change in the rate of urine flow.
In the conscious dog glucagon was given as a bolus of 22 μg/kg followed by an infusion for 45 min. An infusion of 88 μg/kg h produced complete inhibition for 39·2 (± 2·41 s.e.) min. Propantheline, hyoscine, morphine, pethidine and buprenorphine were given in equivalent therapeutic human doses, but no consistent effect on ureteric peristalsis was seen. Glucagon may have a role to play in the management of ureteric colic.
Traumatic pericardiophrenic hernia: A report of 3 cases
Authors: Adamthwaite D N , Snyders D C , Mirwis J 
Published: March 2007

Abstract
Three cases of traumatic intrapericardial diaphragmatic hernia are reported. The defect was limited to the central tendon of the diaphragm in all 3 cases with herniation of the transverse colon (n = 2) or small bowel (n = 1) into the pericardial sac. A correct preoperative diagnosis was made in all 3, using a dilute barium meal in 2 patients, and from the chest X-ray examination alone in 1. Successful operative repair was performed. Previous reports suggest that barium studies of the gastrointestinal tract are the most accurate method of diagnosis but should be used with caution as they may precipitate cardiac tamponade through distension of herniated bowel.
A comparison of Nissen fundoplication and Boerema gastropexy in the surgical treatment of gastro-oesophageal reflux in children
Authors: De Laet M , Spitz L 
Published: March 2007

Abstract
The results of surgical treatment of gastro-oesophageal reflux in 133 infants and children clearly demonstrated the superiority of the Nissen fundoplication over the Boerema gastropexy. The failure to control reflux in the gastropexy group (50 patients) was 42 per cent compared with a 9·6 per cent failure rate in the fundoplication group (83 patients). This resulted in a reoperation rate of 24 per cent for the gastropexy procedure compared with 8 per cent for the fundoplication. There was no difference in the incidence of postoperative complications.
Latissimus dorsi breast reconstruction—refinement and results
Authors: Mendelson B C 
Published: March 2007

Abstract
The surgical objectives for an improved breast reconstruction are defined. In 30 latissimus dorsi flap breast reconstructions only 1 major flap complication occurred. There were 7 lesser complications involving the donor wound on the back (n = 4), the flap (n = 2) and the mastectomy skin (n = 1). Several refinements in the technique provide for a more accurate replacement of the missing breast yet minimize complications on the back. A one-stage reconstruction (with immediate insertion of the prosthesis) is shown to be safe, except in the presence of recognizable damage to the thoracodorsal vascular pedicle. It is concluded that refinements in the use of the flap allow for a better breast reconstruction and that major complications are avoidable.
Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: A study of distal intramural spread and of patients' survival
Authors: Williams N S , Dixon M F , Johnston D 
Published: March 2007

Abstract
Fifty consecutive specimens, obtained in the course of potentially curative abdominoperineal resection for rectal carcinoma situated 5–10 cm from the anal verge, were examined for the presence of microscopic distal intramural spread. Thirty-eight patients (76 per cent) were found to have no distal intramural spread. Seven patients (14 per cent) had spread for 1 cm or less and only 5 patients (10 per cent) had spread of more than 1 cm. Each of these 5 patients had a poorly differentiated Dukes' C carcinoma and each was dead or dying from distant metastases within 3 years of the operation. The results of anterior resection for carcinoma of the rectum were reviewed a minimum of 5 years after operation, to find out whether patients with a wide distal margin of resection had fared better than patients with a small margin. Seventy-nine patients had undergone a potentially curative resection, 48 with a distal margin of less than 5 cm (mean 2·8 cm; group 1) and 31 with a distal margin greater than 5 cm (mean 6·5 cm; group 2). The two groups were well matched for age, sex, degree of differentiation of the tumours and distance of the lesion from the anal verge, but 54 per cent of patients in group 1 had Dukes' grade C tumour whereas only 23 per cent of the patients in group 2 had Dukes' C tumours. Despite the higher proportion of unfavourable tumours in group 1, the outcome, in terms both of survival and of recurrence, was as good in the patients with the small distal margin as in the patients with the wide distal margin of clearance. The rigid, routine application of the 5 centimetre rule' of distal excision may cause patients with low rectal cancer to lose their anal sphincter unnecessarily.
Extrahepatic biliary atresia: A review of current management
Authors: Howard E R 
Published: March 2007

Abstract
Macroscopic examination of the extrahepatic bile ducts in infants with biliary atresia reveals fibrous occlusion of variable extent from an inflammatory process of unknown aetiology. Histological studies have shown that bile duct remnants at the porta hepatis frequently contain small epithelium-lined channels which communicate with intrahepatic ducts and through which effective bile drainage may be established by the operation of portoenterostomy. The 4-year survival rate in untreated cases is 2 per cent, but surgical treatment can improve the outlook and recent reports suggest that a 5-year survival rate of over 35 per cent can be achieved with portoenterostomies performed before 10 weeks of age. Complications after surgery include progressive liver disease, ascending bacterial cholangitis and portal hypertension.
Diagnosis and outcome of testicular torsion
Authors: Thomas W E G , Williamson R C N 
Published: March 2007

Abstract
In a prospective study of 80 patients with acute testicular pain, static and dynamic scans of the scrotum were obtained by radionuclide imaging. Seven patients with acute testicular torsion were identified by gross reductions in isotope uptake. Enhanced uptake (indicating hyperaemia) was seen in 37 patients with acute epididymitis, testicular tumour or resolved torsion. Late torsion and some tumours demonstrated a ‘halo’ sign, with central necrosis and a peripheral increase in blood supply. A group of 22 patients with previous orchidopexy for torsion was reviewed 2–5 years postoperatively. In 15 the previously twisted testis was &gt; 10 per cent smaller than its opposite member and 12 patients showed severe abnormalities of seminal analysis. Hormonal profiles were generally normal. Retention of testes damaged by ischaemia may risk autoimmunization against spermatogenesis.
Oesophageal carcinoma associated with corrosive injury—prevention and treatment by oesophageal resection
Authors: Ti T K 
Published: March 2007

Abstract
Six patients (5 from Kuala Lumpur and 1 from Singapore), who had a history of corrosive injury in late adolescence and early adult life, developed oesophageal squamous cell carcinoma. The association between corrosion and carcinoma was probably causal in 5 women who developed oesophageal cancer 25–50 years after corrosive injury and coincidental in a 35-year-old man with a recent history of corrosive ingestion. The 5 patients from Kuala Lumpur were among a series of 49 patients treated over a 10-year period for dysphagia from corrosive injury. Excluding the patient with coincidental association, the 4 patients with corrosive-induced carcinoma represent an 8 per cent incidence of malignancy in the series of 49 patients. Reference is made to the safety of oesophageal resection in 28 patients with associated carcinoma. Oesophageal resection during reconstructive surgery for severe corrosive stricture would have a preventive role in corrosive induced carcinoma. However, these cases suggest that patients with relatively mild corrosive injury not requiring reconstructive surgery are also at risk of oesophageal carcinoma. An awareness of this risk should lead to earlier diagnosis of carcinoma and an increase in the number of curative resections.
Axillofemoral and femorofemoral grafts: A 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival
Authors: Graham J C , Cameron A E P , Ismail H I , Hamilton W A P , Law Y F , Roberts V C , Cotton L T 
Published: March 2007

Abstract
Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of &lt; 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.
Oesophagitis in patients undergoing oesophageal transection for varices—a histological study
Authors: Spence R A J , Sloan J M , Johnston G W 
Published: March 2007

Abstract
Thirty-one oesophageal rings from patients undergoing transection for varices were examined histologically for oesophagitis. Four cases showed neutrophil infiltration but all had recent oesophageal intubation. Fifteen patients had significant morphological epithelial changes of oesophagitis assessed by two sets of criteria. Only 4 of these patients (13 per cent) had no other likely causative factor such as recent sclerotherapy or recent insertion of a Sengstaken tube. Therefore there appears little evidence for oesophagitis as a major aetiological factor in bleeding oesophageal varices.
Pulsion intubation v. retrosternal gastric bypass for palliation of unresectable carcinoma of the upper thoracic oesophagus
Authors: Angorn I B , Haffejee A A 
Published: March 2007

Abstract
The optimum method of restoring the ability to swallow in patients with oesophageal carcinoma remains controversial. This prospective randomized study evaluates the palliative potential of pulsion intubation v. retrosternal gastric bypass of the excluded oesophagus in 106 patients with unresectable carcinoma; 55 patients were intubated and 51 patients treated by gastric bypass. The operative mortality and morbidity, palliation of dysphagia and postoperative nutritional status were compared in the 2 groups. Intubation resulted in 3 deaths (5·5 per cent) and gastric bypass in 4 deaths (7·8 per cent). Intubation was complicated by chest infection in 13 patients (24 per cent) but complications related to the procedure occurred in only 5 patients and included tube migration (2), respiratory obstruction (1), bleeding (2) and oesophageal perforation (1). Gastric bypass was complicated by chest infection in 14 patients (27 per cent), but procedure-related complications were common and included pneumothorax (3), wound infection (6), subphrenic abscess (2), anastomotic leak (5) and purulent neck discharge (3). Palliation of dysphagia was achieved in 93 per cent of patients following intubation and 92 per cent of patients following bypass. Nutritional status improved more rapidly following intubation. Pulsion intubation is the preferred palliative procedure because of fewer complications and a lesser degree of postoperative catabolism.
A prospective randomized trial of vagotomy in chronic duodenal ulceration: 4-year follow-up
Authors: Koffman C G , Hay D J , Ganguli P C , Elder J B , Gillespie I E , Mantoudis S M , Tweedle D E F , Schofield P F , Palmer M 
Published: March 2007

Abstract
A total of 153 patients (124 male and 29 female) with uncomplicated chronic duodenal ulceration were studied in a prospective, randomized trial of proximal gastric vagotomy (PGV) and truncal vagotomy and pyloroplasty (TVP), conducted in four Manchester hospitals. Of these, 137 patients have now been followed up for 2·5 to 5·5 (mean 4·1) yr. There have been 15 (21 per cent) recurrent ulcers following PGV compared with 5 (7·5 per cent) after TVP (P &lt; 0·05). A satisfactory functional result was obtained in 82 per cent of patients after TVP compared with 73 per cent following PGV and there was little difference between the groups with regard to the incidence of dumping, heartburn and vomiting. There was significantly more diarrhoea following TVP (13 per cent) compared to PGV (1·4 per cent) but this represented only a minor clinical problem.
Symptoms and signs of operable breast cancer 1976–1981
Authors:   The Yorkshire breast cancer group, Benson E A 
Published: March 2007

Abstract
The symptoms and signs of operable breast cancer in 1205 women are reviewed, and in a considerable proportion classic signs are absent. Of the patients 73 per cent were postmenopausal and 76 per cent of cancers presented as discrete lumps. Pain as a presenting symptom was rare (5 per cent), but when questioned 33 per cent of women admitted that the lump was painful. Some 42 per cent of patients had skin tethering or fixation, only 22 per cent had nipple retraction or displacement, and 42 per cent had lesions which appeared to have well-defined edges. Only 32 per cent of lesions were clinically T0 or T1, the majority (56 per cent) being T2, and 12 per cent were T3.
Gastric ulceration after Nissen fundoplication
Authors: Campbell R , Kennedy T , Johnston G W 
Published: March 2007

Abstract
Thirteen patients developed gastric ulcers between 6 months and 8·5 years after Nissen fundoplication. Eight patients presented with epigastric pain alone, 3 with bleeding alone and 2 with both pain and bleeding. Nine ulcers (69 per cent) were high on the lesser curve, close to the fundoplication and 7 of these patients had recurrent hernias. Anatomical distortion produced by fundoplication is probably the most important aetiological factor, though gastric distension, bile reflux gastritis and ischaemia may be contributory.