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A series of 29 patients with primary biliary cirrhosis has been studied in the last seven years. An unusual feature of this group was that 38% wee over the age of 65, and 24% over the age of 70 at presentation. Detailed analysis of the seven patients presenting over the age of 70 is provided. All of these patients had symptomatic primary biliary cirrhosis rather than representing prolonged survival of the asymptomatic state. It is important that primary biliary cirrhosis be included in the differential diagnosis of liver disease presenting in the elderly. [ABSTRACT FROM AUTHOR]

In a randomised, double blind, parallel group study in patients with symptomatic gastric ulcer (94% greater than or equal to 5 mm diameter), 102 received omeprazole 20 mg om and 87 cimetidine 400 mg bd. After four weeks 73% and 58% (p less than 0.05) respectively had healed (eight weeks: 84% and 75%, ns). After four weeks, a greater proportion (81%) of omeprazole treated patients was symptom free than of those receiving cimetidine (60%; p less than 0.01). Over the first two weeks, patients receiving omeprazole had less day pain, less night pain and took fewer antacids than those receiving cimetidine (all p less than 0.05). The difference between omeprazole and cimetidine was not appreciably affected by age, smoking, size of the ulcer and trial centre. Tolerability was similar in the two treatment groups. In the treatment of symptomatic gastric ulcer, omeprazole relieves the symptoms more quickly than cimetidine and heals a greater proportion of ulcers within four weeks. [ABSTRACT FROM PUBLISHER]

Using an indirect immunofluorescence technique liver membrane antibodies of IgG and IgA class have been demonstrated in a statistically significant proportion of sera from patients with alcoholic hepatitis and alcoholic cirrhosis. IgG and IgA class antibodies were found respectively in 23 and 25% of 48 patients with alcoholic hepatitis, in 27 and 33% of 84 with active cirrhosis, and 67 and 58% of 12 with inactive cirrhosis. These results provide evidence of a humoral immune response in alcoholic liver disease which is directed against, as yet undefined, liver-cell membrane antigens. [ABSTRACT FROM PUBLISHER]

A fatal case of post-myocardial infarction syndrome (PMIS) followed by a rupture of an inferior left ventricular aneurysm is described. Attention is drawn to the growing number of reports of aneurysm in PMIS, and the clinico-pathological significance of this association is discussed. [ABSTRACT FROM PUBLISHER]

A study of HLA-A and B antigens in 248 patients with biopsy diagnosed alcoholic liver disease was conducted to examine for a genetic predisposition to alcohol related liver injury. No statistically significant differences were established for 8 HLA-A and 16 HLA-B antigens between normal healthy controls (n = 342) and patients with alcoholic fatty liver (n = 86), alcoholic hepatitis (n = 63), active alcoholic cirrhosis (n = 64) and inactive alcoholic cirrhosis (n = 35). It is concluded that no HLA-A or B locus genetic susceptibility to alcoholic related injury could be shown. [ABSTRACT FROM PUBLISHER]

Postoperative prognostic stratification using the Union for International Cancer Control (UICC) TNM 8th edition staging rules (UICC 8) may identify additional groups of patients who could benefit from adjuvant radiotherapy. Currently, selection for such treatment is not based on all known prognostic factors, and their relative importance may vary depending on the overall risk category. The objective of this study therefore was to evaluate these possibilities. We retrospectively studied 644 patients who had surgery with curative intent for oral squamous cell carcinoma (OSCC) between March 2006 and February 2017. The outcomes of interest were disease-specific survival (DSS) and locoregional recurrence (LRR). Patients were re-staged according to the UICC 8 staging rules. Putative clinical and pathological prognostic variables were evaluated and hazard ratios estimated. Regression analysis was done to identify independent prognostic factors, and iterative analyses identified clinically-relevant risk categories with a minimum of residual prognostic variables. The significance of recognised pathological prognostic factors differed according to the overall risk category. An intermediate risk group comprising patients with pN1 disease as well those with pT3 disease solely on the basis of a depth of invasion (DOI) of more than 10 mm, was identified. A trial to evaluate the benefit or otherwise of adjuvant radiotherapy in this group is now required. Individual prognostic risk factors should be considered within the context of the overall risk category in patients with OSCC., (Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.)

To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive., (Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.)

We prospectively studied patients from the west of Scotland who presented with a primary cancer of the oral cavity or oropharynx over a period of 24 months from November 1999, and report long-term outcomes and prognostic factors. A total of 481 patients had squamous cell carcinoma (SCC), 5-year disease-specific survival (DSS) was 50%, and overall survival (OS) was 35%. One hundred were not suitable for treatment with curative intent, and factors other than stage were important in this decision. Of those treated with curative intent, 249 had SCC of the oral cavity (5-year DSS 67%; OS 42%), and 132 had SCC of the oropharynx (5-year DSS 62%; OS 42%). Multivariate analysis showed that pathological nodal stage (p=0.051, 95% CI 0.998-1.955), and perineural invasion (p=0.001, 95% CI 0.186-0.666) were prognostic indicators. Improved results using intensive treatment protocols that have been seen in trials are not likely to translate directly into a general population of patients with head and neck cancer. Algorithms that allow several pathological prognostic indicators to be incorporated into decisions about adjuvant treatment should be used., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

We present a summary of a prospective study of 50 consecutive cases into the morbidity associated with open reduction and internal fixation of the fractured mandibular condyle through the transparotid approach. It is acceptably safe, and the data can now be presented to patients to help them make an informed choice about options for treatment.

We present a protocol for the management of a subgroup of patients with bisphosphonate osteonecrosis who presented with painful, exposed, necrotic, alveolar bone. It is simple and can easily be adapted to suit anatomical variations of the oral cavity. Current guidelines based on consensus for the management of bisphosphonate-induced osteonecrosis fail to provide mucosal coverage, which is a primary requirement in managing the condition. We have evaluated the results of a group of 15 patients and analysed their postoperative progress for 24 months.

Aim: To compare the pre-existing management of patients with Hepatorenal Syndrome (HRS) in the gastroenterology unit of the Royal Alexandra Hospital, Renfrewshire, with the published evidence based studies., Method: A retrospective, 6-month, case record review of patients diagnosed with HRS was performed. An evidence-based protocol for the diagnosis and management of HRS was introduced into the unit, to aid patient treatment prospectively. After 6 months, both compliance with the protocol, and patient outcomes were analysed., Results: Eleven patients were identified in the first part of the audit cycle, all of whom died. Seven were identified in the second cycle. Two had their renal function successfully corrected and one was discharged from hospital. Renal impairment and staging of liver disease was equivalent in both groups. The second group received more appropriate and aggressive therapy. Alcohol was the causative aetiology of liver disease in all patients., Conclusions: Targetted therapy in patients with severe liver disease and HRS can improve renal parameters. Previous studies have shown this to be linked with improved patient outcomes.

Treatment of fractured mandibular condyles remains controversial. In this paper we present data collected prospectively on 42 fractured condyles treated by open reduction and internal fixation. The central issue, which is sometimes forgotten, is the informed consent of our patients. To this end we have looked at the surgical morbidity related to the retromandibular approach., (Copyright 2002 The British Association of Oral and Maxillofacial Surgeons.)

Diaphragmatic paresis following trauma to the phrenic nerves is a rare complication after neck surgery. The resulting elevation of the ipsilateral hemi-diaphragm is diagnosed on post-operative chest radiography and may be confirmed by ultrasound or fluoroscopy. When unilateral, this may lead to respiratory, cardiac or gastrointestinal symptoms and atelectasis and pulmonary infiltrates on radiography. If nerve damage is bilateral a period of ventilation may be required.

An in-house audit revealed a theatre utilization time in the day surgery unit of 70%. The reason identified for this poor theatre utilization was patient selection by the clerical staff based on a fixed number of cases per session. A grading system which estimated the anticipated duration of operation time was introduced as the basis for patient selection in the day surgery. A pilot study of 20 patients revealed that the system was both effective and simple to implement. It was therefore adopted. A re-audit of a further 299 patients treated using the grading system revealed that theatre utilization time had increased from 70 to 98%. The number of patients treated per session also increased, thus effectively reducing the waiting list. The grading system can be used in all clinical specialities providing day case surgery and we recommend it.

Retrobulbar haemorrhage is a rare complication of orbital injury or surgery. After injury the first clinicians to see these patients are often the staff of accident and emergency departments. This survey was instigated after several patients had been referred to our care irreversibly blind. A multiple choice questionnaire was devised and sent to 90 doctors working in accident and emergency departments in Scotland. A total of 57 (63%) were returned of which 55 were complete enough to analyse. The range of respondents was: consultants (n = 6), associate specialists (n = 3), senior registrars (n = 3), registrars (n = 4), senior house officer (n = 35), and clinical assistants (n = 4). Twenty nine of the 35 senior house officers (83%) were unable to diagnose and treat retrobulbar haemorrhage. Most consultants, senior registrars, registrars and associate specialists were significantly better in the diagnosis and treatment of this condition (P = 0.001). We conclude that there is an unacceptably high incidence of blindness as a result of inappropriate diagnosis and treatment of retrobulbar haemorrhage. We have therefore designed a protocol for accident departments which should help reduce the incidence of blindness.

Background/aims: Dilatation combined with subsequent pharmacological control of gastroesophageal reflux represents a logical but poorly documented approach to the management of benign esophageal stricture. This large trial (366 patients) aimed to assess whether omeprazole as the most effective available medication for gastroesophageal reflux disease prevents recurrent stricture formation., Methods: Patients (n = 366) were randomized in a double-blind study to undergo either omeprazole (20 mg once daily; 180 evaluable patients) or ranitidine therapy (150 mg twice daily; 185 evaluable patients) for 1 year after dilatation to 12-18-mm diameter (36-54F gauge). Subsequently, endoscopy and dilatation were performed when clinically indicated and endoscopy on completion. Symptoms were assessed at clinic visits every 3 months and using weekly diary cards., Results: Fewer patients undergoing omeprazole therapy required redilatation compared with those on ranitidine (43 of 143 [30%] vs. 66 of 143 [46%] by 12 months; P < 0.01), and patients in the omeprazole group needed fewer redilatations during the year (0.48 vs. 1.08; P < 0.01). On completion, symptom relief favored omeprazole: 76% of patients in the omeprazole group were free of dysphagia (compared with 64% in the ranitidine group; P < 0.05); 83% were able to accept a normal diet (69%; P < 0.01); and 65% were completely asymptomatic (43%; P < 0.001)., Conclusions: Omeprazole, 20 mg once daily, was more effective than ranitidine, 150 mg twice daily, as prophylaxis against stricture recurrence and in providing symptom relief.

Anorganic bovine bone has been used previously to obturate bony defects following apical surgery with some reported success. However, no prospective trial has been carried out. We present the results of our trial showing that the placement of anorganic bovine bone (BIO-OSS) in defects created by apical surgery is contraindicated.

Anorganic bovine bone has been used in oral and maxillofacial surgery for several years. Its use has been limited to ridge augmentation. In this paper we have tried to evaluate its use in other settings within the speciality.

Five female patients with Klippel-Feil syndrome (KFS) are presented with abnormal bony masses in the mandibular ramus region. The features of KFS are described with assessment and treatment of the five patients. Although congenital duplication of mandibular rami in KFS has been previously documented, we believe this is the first series of patients with this deformity.

We report the 10-year survival of 510 patients with a histological diagnosis of alcoholic liver disease. Eight centres in Scotland and North England contributed to this study. Information was available on 92% of the initial cohort. Age was important, with each decade increasing mortality by 55%. A highly significant interaction between sex and histology was observed with a marked survival benefit for males with non-cirrhotic alcoholic liver disease, while in cirrhotic subjects the pattern was reversed. Patients with decompensated liver disease had a relative increase in mortality in excess of 86% while the increase in mortality for alcoholic hepatitis, 'active' cirrhosis and 'inactive' cirrhosis were 52%, 57% and 91% relative to fatty liver. Alcohol intake at the time of diagnosis did not influence outcome. This study emphasises yet again the increased mortality rate of individuals abusing alcohol compared with the general population.

The strain of Chlamydia psittaci causing enzootic abortion in ewes (the EAE strain) may cause serious infection in pregnant women, often resulting in hepatic and renal dysfunction, disseminated intravascular coagulation and fetal loss. The first case of such an infection in an abattoir worker is described and the possibility of human-to-human transmission considered. Direct handling of sheep or their products of conception can usually be established but this is not always so. There is much still to be learned about this uncommon but severe zoonosis.

Removal of tumours from the parapharyngeal space is often difficult because of limited surgical access. Mandibulotomy has proved useful for improving access but may cause damage to the inferior dental and lingual nerves. Use of the inverted 'L' osteotomy provides excellent access avoiding damage to the nerves and the technique is illustrated with three surgical cases.

A study of 510 patients in Scotland and northeastern England with histological evidence of alcohol-induced liver disease showed no difference in the age of presentation between males and females. Single men and widowed females were particularly susceptible to alcoholic liver disease. The social class distribution was similar to the population in general. Women were more reluctant to volunteer a history of alcoholism than men, they had a higher incidence of previous psychiatric illness (usually due to alcohol abuse) and they developed liver disease at lower consumption thresholds of alcohol than men. Patients under 40 years of age were more likely to have alcoholic fatty liver and less likely to have active cirrhosis than those over 40. Most often, the presenting symptoms were non-specific and tended to be related to the gastrointestinal system, particularly in women. Five per cent of patients were asymptomatic and 14% came to hospital for conditions other than alcoholic liver disease. Important clues to asymptomatic alcoholic liver disease included hepatomegaly, clubbing of the fingers and abnormal liver function tests. Gastro-oesophageal varices accounted for 40% of instances of haemorrhage and the mortality from upper gastrointestinal bleeding was 17%. Anaemia was the most common haematological abnormality. Alcoholic hepatitis was observed more frequently in the Glasgow area then elsewhere.