bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening patients with claudication from femoropopliteal disease before angioplasty using Doppler colour flow imaging
Authors: Whyman M R , Gillespie I , Ruckley C V , Allan P L , Fowkes F G R
Published: March 2007

Time, expense, risk and discomfort are incurred by arteriography in patients with intermittent claudication who might be candidates for percutaneous transluminal angioplasty (PTA). A valid screening technique could reduce the need for arteriography in patients found to have lesions not amenable to PTA. Agreement between Doppler colour flow imaging (DCFI) and angiography for detecting haemodynamically significant lesions is high, but DCFI may not identify lesions suitable for angioplasty. A total of 36 limbs in 30 patients were studied using DCFI before angiography. Agreement between the two methods was excellent (κ = 0.91), and the predictive accuracy of DCFI for lesions amenable to PTA was good (κ = 0.78, sensitivity 94 per cent, specificity 85 per cent, positive predictive value 83 per cent, negative predictive value 94 per cent, overall accuracy 89 per cent). DCFI is a useful screening process that may prevent unnecessary angiography, with consequent financial savings and clinical benefit.
Thromboembolic prophylaxis in total hip replacement: A comparison between the low molecular weight heparinoid Lomoparan and heparindihydroergotamine
Authors: Leyvraz P , Bachmann F , Bohnet J , Breyer H G , Estoppey D , Haas S , Hochreiter J , Jakubek H , Mair J , Sorensen R , Stiekema J
Published: March 2007

In a prospective, randomized, assessor-blind multicentre study two antithrombotic subcutaneous regimens were compared in patients undergoing total hip replacement. Group 1 (1.54 patients) received 750 anti-Xa units of a new low molecular weight heparinoid (Lomoparan) subcutaneously twice a day and group 2 (1.55 patients) received 5000 units heparin and 0.5 mg dihydroergotamine (heparin–DHE 5000) twice a day. The incidence of deep vein thrombosis, assessed by routine bilateral venography on day 10 (±1), was 17 and 32 per cent in groups 1 and 2 respectively (risk reduction 47 per cent; P = 0.007). One patient in each group developed a symptomatic pulmonary embolism confirmed by lung scanning. Major bleeding complications occurred in one patient in each group and no significant difference was observed between the two groups with respect to minor bleeding complications. Subcutaneous Lomoparan appears to be as safe as heparin-DHE 5000 at the above doses with regard to bleeding complications, and is more efficacious with respect to venous thrombosis.
Results of the first year of breast cancer screening in a district hospital
Authors: Bird D L , Fox J N , Ashley S , Imrie M J
Published: March 2007

The Humberside Breast Screening Service completed 1 year of screening by October 1990; 16 534 women were invited of whom 12832 (77.6 per cent) attended. A group of 644 women (5.0 per cent) were called for further assessment and of these 134 underwent 135 primary surgical procedures. After assessment 25 were shown before operation to have cancer. One hundred and nine women had suspicious lesions and proceeded to surgical biopsy; 50 lesions proved malignant (benign: malignant biopsy ratio 1.2:1). The 75 malignant lesions represented a prevalence of 5.8 per 1000 of the screened population. Invasive cancer > 1 cm in diameter formed almost half of the malignant lesions. This service has cost £32 per woman screened or £5533 per cancer detected. The results are comparable to those of previous studies and suggest that a mammographic screening service can be successfully provided in a district hospital setting.
Assessment of non-palpable mammographic abnormalities: Comparison between screening and symptomatic clinics
Authors: Aitken R J , Forrest A P M , Chetty U , Roberts M M , Huggins A , MacDonald H L , Muir B B , Kirkpatrck A E , Anderson T J
Published: March 2007

A retrospective study found that a breast screening clinic generated fewer localization biopsies for non-palpable mammographic abnormalities than a symptomatic clinic (3.36 versus 9.89 per 1000 mammograms, respectively) and that a greater proportion of such biopsies were malignant. This study determined the reason for this difference. There were 108 of 304 (35.5 per cent) and 17 of 130 (13.1 per cent) carcinomas in women attending the screening and breast clinics respectively (relative risk 2.72 (95 per cent confidence interval 1.70–4.34)). This difference was regardless of age. The characteristics of the mammographic abnormality, the Wolfe pattern, a family history of breast carcinoma, parity and age at first pregnancy were similar in both groups. Women attending the screening clinic were referred for localization biopsy after assessment by clinicians and radiologists at a joint clinic; there was no joint assessment for patients attending the breast clinic. The same staff attended both clinics, although the proportion of time spent at each varied. This study suggests that all women with a non-palpable mammographic abnormality should be reviewed at a joint assessment clinic before localization biopsy is recommended.
Isolated hyperthermic liver perfusion with cytostatic-containing perfusate activates the complement cascade
Authors: Arnestad J P , Bengtsson A , Bengtson J-P , Henriksson B-Å , Stenqvist O , Naredi P , Hafström L
Published: March 2007

Eight patients with advanced liver malignancy undergoing isolated hyperthermic liver perfusion with melphalan and cisplatin were studied with regard to complement activation and formation of anaphylatoxins (C3a and C5a) and terminal C5b-9 complement complexes (TCCs). Blood samples for complement variables (C1-INH, C3, C4, C5, C3a, C5a and TCCs) were taken before surgery, 1 min before the start of perfusion, 1, 2 and 3 h after the start of perfusion, and 24 h after operation. Samples were drawn from the perfusate 1 h after the start of perfusion. Activation of complement was observed during perfusion. Raised plasma concentrations of C3a and TCCs were recorded and high levels of C3a and TCCs were found in the perfusate. In vitro tests indicated that melphalan and cisplatin may activate complement. This activation occurred at 37 and 42°C but was more pronounced at 42°C.
Biodistribution of Lipiodol following hepatic arterial injection
Authors: Hind R E , Loizidou M , Perring S , Fleming J , Batty V , Birch S , Taylor I
Published: March 2007

Thirteen patients undergoing selective coeliac angiography before insertion of an indwelling hepatic arterial cannula underwent injection of 3 ml radiolabelled Lipiodol (2 MBq 131I) into the hepatic artery at the end of the procedure. At subsequent laparotomy 1–9 days later, biopsies were taken from normal liver and metastases. The radioactivity of this material was measured to establish the tumour: liver ratios. Two patients with large metastases (> 10 cm in diameter) had low ratios. In the remainder, the median ratio at 24 h was 1.5:1 (range 1.1–2.5:1;n = 5) and 2.6:1 (range 1.5–64.0:1;n = 6) at 3–9 days. Four patients underwent single photon emission computed tomography, which confirmed selective retention of Lipiodol in small metastases, although no activity was detected in a large deposit (> 15 cm) 10 days after injection. The tumour: liver ratio in the other three patients increased from 3.0–5.6:1 on day 1 to 4.5–7.2:1 on day 6. This study suggests that Lipiodol may be a useful therapeutic delivery agent to small colorectal liver metastases.
Non-steroidal anti-inflammatory drugs and appendicitis in patients aged over 50 years
Authors: Campbell K L , De Beaux A C
Published: March 2007

In a retrospective study 84 patients aged ⩾ 50 years undergoing emergency appendicectomy were matched for age and sex with 84 randomly selected emergency admissions as controls. Of the former, 31 (37 per cent) were taking non-steroidal anti-inflammatory drugs (NSAIDs) at admission, compared with nine (11 per cent) of the controls (P < 0.01). In the study group a suppression of the white cell count was identified on admission in those taking NSAIDs (mean 11.9 × 109 l−1) compared with those not (mean 14.8 × 109 l−1) (P = 0.007). This is the first reported association between appendicitis and NSAIDs. The relative risk by odds ratio was substantially increased at 6.5 (95 per cent confidence interval 2.1–8.8). An NSAID-related impairment of host defences leading to failure in the resolution of inflammatory episodes may explain this association. It is further postulated that the suppression of the white cell response may be a marker of such an effect.
Risk of rupture of postangiographic femoral false aneurysm
Authors: Graham A N J , Wilson C M , Hood J M , D'Sa A A B Barros
Published: March 2007

The surgical management of 50 false aneurysms caused by transfemoral arterial catheterization was reviewed to document the incidence and effects of rupture before repair. Twelve false aneurysms ruptured, leading to shock in six patients, distal ischaemia in three and stroke in one. The mean(s.d.) time, from catheterization to rupture was 2.8(1.7) (range 1-6) days. Postoperative complications occurred in seven patients with ruptured and eight with non-ruptured aneurysms (P < 0.04). The mean(s.d.) age of patients with ruptured aneurysms was 67.2(6.3) (95 per cent confidence interval 63.5–70.8) years and those without 58.5(9.1) (95 per cent confidence interval 55.3–61.7) years (P < 0.008). On multiple regression analysis, age, peripheral vascular disease and raised plasma liver enzyme levels on admission were found to be significant independent predictive variables for rupture (all P < 0.05). It is recommended that patients with these risk factors undergo urgent operative correction of femoral false aneurysm.
Physiological and metabolic responses to open and laparoscopic cholecystectomy
Authors: Mealy K , Gallagher H , Barry M , Lennon F , Traynor O , Hyland J
Published: March 2007

This study examined respiratory function and metabolic and subjective responses in patients undergoing laparoscopic (n = 10) and open (n = 11) cholecystectomy for chronic cholecystitis and biliary colic. Patient groups were matched for age, sex, weight and height. The duration of operation was similar in both groups. Respiratory function tests (vital capacity, forced expiratory volume in 1 s, peak flow and arterial blood gases), urinary cortisol, vanillylmandelic acid, metanephrines and nitrogen loss, serum complement component C3 and C-reactive protein (CRP), full blood count, erythrocyte sedimentation rate (ESR) and subjective responses as assessed on a pain analogue scale and by analgesic usage were determined for up to 48 h after surgery. Deterioration in perioperative respiratory function was significantly less for laparoscopic surgery. Arterial blood gas determinations indicated a greater perioperative decrease in arterial pH, with carbon dioxide retention in patients undergoing open cholecystectomy (P < 0.02), reflecting poorer respiratory performance. Hormonal profile changes demonstrated an increase in urinary vanillylmandelic acid in the laparoscopic cholecystectomy group (P < 0.04); no differences were detected in urinary cortisol, metanephrine or nitrogen excretion. Acute-phase responses were greatest in patients undergoing open cholecystectomy as determined by ESR and CRP level (P < 0.02 and P < 0.003, respectively). Pain and analgesic usage were significantly decreased in the laparoscopic cholecystectomy group (P < 0.0009 and P < 0.0001), which led to a decreased hospital stay after operation in these patients (P < 0.0001). These data indicate improved respiratory and subjective responses and diminished acute-phase responses associated with laparoscopic surgery. Catabolic hormone release may, however, be increased.
An improved means of faecal diversion: The trephine stoma
Authors: Anderson I D , Hill J , Vohra R , Schofield P F , Kiff E S
Published: March 2007

Twenty-four patients in whom trephine stoma formation was performed over a 4-syear period are described. This procedure permits the formation of an endileostomy or colostomy without laparotomy. It is simple, rapid, safe and allows speedy recovery. It is widely applicable and previous abdominal surgery is no contraindication. The procedure was impossible in two patients who required laparotomy and in a third in whom a loop colostomy was created. Operation time was shorter and postoperative opiate requirements less than when laparotomy was undertaken for stoma formation. Follow-up (median 1 year) of 17 patients confirmed a low incidence of complications (two prolapses, one parastomal hernia) after trephine stoma formation. This procedure is recommended as the preferred method of ileostomy or colostomy formation when laparotomy is not otherwise indicated.
Encephalopathy in patients with extrahepatic obstruction after lienorenal shunts
Authors: Mohapatra M K , Mohapatra A K , Achary S K , Sahni P , Nundy S
Published: March 2007

Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.
Function of the human colon
Authors: Moran B J , Jackson A A
Published: March 2007

Despite the volume of research on human colonic dysfunction, little is known about colonic function in health. This has stemmed partly from the dificulty in obtaining access to the organ. Two approaches have been used: studies on patients with stomas, and intestinal intubation techniques. The colonoscope has also recently been used to gain access. All these methods have limitations and results must be interpreted with caution. The accepted roles of the colon include the conservation of water and electrolytes and the controlled evacuation of faeces. Recent research has demonstrated its importance as a metabolic organ with an influence on overall metabolism, an effect that may in large part be attributed to the activity of colonic microflora. Evidence demonstrating that the defunctioned colon behaves differently from the functioning colon in the same individual has implications for a proper understanding of the organ, as practically all previous in vivo studies have been conducted in cleansed or defunctioned human colon.
Aetiology and treatment of chylous ascites
Authors: Browse N L , Wilson N M , Russo F , Al-Hassan H , Allen D R
Published: March 2007

A series of 45 patients with chylous ascites has been reviewed. The age at presentation ranged from I to 80 (median 12) years; 23 patients were aged ≦15 years. Thirty-five patients had an abnormality of the lymphatics (primary chylous ascites); in the remaining ten, the ascites was secondary to other conditions, principally non-Hodgkin's lymphoma (six patients). Two principal mechanisms of ascites formation were identified using lymphangiography and inspection at laparotomy: leakage from retroperitoneal megalymphatics, usually through a visible lymphoperitoneal fistula (14 patients); and leakage from dilated subserosal lymphatics of the small intestine, invariably associated with leaking lacteals causing protein-losing enteropathy (24 patients). Both sites of leakage were present in a further five patients. In the remaining two patients, chyle was leaking from normal mesenteric lymphatics, in one via a ruptured mesenteric lymph cyst and in the other from the site of a previous lymph node biopsy. Other associated lymphatic abnormalities were present in 36 patients, lymphoedema of the leg being the commonest (26 patients). All patients were initially treated conservatively with dietary manipulation: this as the most satisfactory treatment for those with leaking small bowel lymphatics. Surgery (fistula closure, bowel resection or insertion of a peritoneovenous shunt) was performed in 30 patients. Closure of a retroperitoiieal fistula, when present, was the most successful operation, curing seven of the 12 patients so treated.
In vivo assessment by videomicroscopy of acute renal microvascular responses to cyclosporin
Authors: Abraham J S , Bentley F R , Garrison R N
Published: March 2007

Nephrotoxicity limits the use of cyclosporin A for immunosuppression after organ transplantation and may be caused by glomerular hypoperfusion. Indirect studies have shown that cyclosporin A increases renal vascular resistance and reduces total renal blood flow. This study used direct in vivo videomicroscopy to define the efects of the drug on the renal microcirculation of the rat. An intravenous infusion of cyclosporin A (20 mg per kg body-weight) caused a 13 per cent acute constriction of the proximal interlobular artery and an associated 29 per cent reduction in preglomerular interlobular arterial blood flow. There was a simultaneous increase in mean arterial blood pressure of 34 per cent caused by cyclosporin A and a 23 per cent increase in systemic vascular resistance. Cyclosporin acutely reduces renal microvascular blood flow by vasoconstriction and afects the central circulation, suggesting that a generalized peripheral vasoconstriction is induced.
Metastasectomy
Authors: Barr L C , Skene A I , Meirion Thomas J
Published: March 2007

The literature on metastasectomy abounds in anecdote and retrospective studies of non-randomized patients. In this paper, the published evidence concerning the efficacy of metastasectomy in the lung, liver, brain, gastrointestinal tract and omentum is reviewed to formulate practical recommendations for patient selection and treatment. At some sites metastasectomy can be recommended with little hesitation for more widespread application, but surgery for liver metastases should still be regarded with some reservation.
Management of Gulf War casualties
Authors: Souka H M
Published: March 2007

During the Gulf War 84 patients underwent surgery in the Jubail Armed Forces Hospital, Saudi Arabia. The median time to evacuate casualties to hospital was 8 h 40 min. Fragments caused 88 per cent of injuries; 11 per cent were caused by bullets. Multiple lesions were encountered in 70 per cent of patients. The extremities (76 per cent) were the most frequently injured site, the lower limbs more so than the upper. Soft tissue injuries prevailed (59 per cent).
Indications for primary tamoxifen therapy in elderly women with breast cancer
Authors: Gaskell D J , Hawkins R A , De Carteret S , Chetty U , Sangster K , Forrest A P M
Published: March 2007

A group of 66 elderly women with primary breast cancer were treated with tamoxifen and followed for a minimum of 2 years. Of these, 32 whose disease remained controlled for the 2-year period were considered to have had a ‚worthwhile‚ response, 27 in whom disease progressed were considered to have had an unsatisfactory result and seven opted for alternative treatment. By Union Internacional Contra la Cancrum (UICC) criteria, 14 women had a complete response, 20 a partial response, in five disease remained static and in 20 it progressed without response. Prediction of outcome after assessment according to UICC criteria at 3 and 6 months was unsatisfactory (19 and 34 of 59 correctly predicted respectively). Analysis of multiple tumour measurements over 12 weeks was no better (33 of 59 correctly predicted). Immunocytochemical assay of fine-needle aspirates for oestrogen receptor (ER) provided a better predictor (38 of 47 correct) and the difference in survival between patients with and without ER activity was significant (P < 0.001). Conventional assessments of response at 3 and 6 months are unsatisfactory for judging the long-term benefit to the patient. ER status is the best predictor of response and outcome.
Autotransplantation of splenic tissue in an isolated segment of small intestine
Authors: Shokouh-Amiri M H , Bayat M , Rahimi-Saber S , Lindkaer Jensen S , Kerndrup G
Published: March 2007

The ability of splenic tissue to regenerate when implanted in an isolated segment of small intestine with intact circulation was studied in six pigs. After total splenectomy, 10 per cent of the weight of the spleen was implanted in a 10–15-cm long isolated segment of small intestine with an intact vascular supply. Bowel continuity was established by end-to-end anastomosis. Before implantation, the mucosal layer was completely removed from the isolated segment of the small intestine. The animals were killed 6 months later and the isolated segment of small bowel containing the splenic tissue identified. Most of the implanted splenic tissue was recovered in the isolated segment of small intestine; the weight ranged from 43 to 120 (mean 80) per cent of that of the implanted tissue. An isolated segment of small intestine with an intact circulation produces a higher index of regeneration than other previously reported sites.
Ascaris-induced acute pancreatitis
Authors: Khuroo M S , Zargar S A , Yattoo G N , Koul P , Khan B A , Dar M Y , Alai M S
Published: March 2007

The incidence, clinical disease and outcome of acute pancreatitis caused by ascariasis in an endemic area of Kashmir, India, was studied prospectively. Ascariasis was an aetiological factor in 59 of 256 patients (23.0 per cent) with acute pancreatitis. Worms had invaded the bile duct in 51 patients, the pancreatic duct in four and both ducts in four. Pancreatitis was mild in 46 patients and severe in 13. Associated pyogenic cholangitis was present in eight. Acute complications occurred in 11 patients. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all cases within 72 h of admission and delineated ascarides in the duodenum invading the ampullary orifice (44 patients), in the bile duct (55) and in the pancreatic duct (eight). At ERCP, worms were extracted from the ampullary orifice and removed via the mouth of 33 patients with intractable epigastric pain, leading to rapid relief of symptoms. The eight patients with pyogenic cholangitis underwent endoscopic nasobiliary drainage to decompress the bile ducts; worms were extracted from the bile duct of three of these patients using a Dormia basket. A total of 56 patients recovered from acute illness with a combination of conservative and endoscopic treatment; the other three required emergency surgery. At a mean(s.d.) follow-up of 19(7) months, ten patients showed symptomatic worm reinvasion of the biliary tree. The overall mortality rate was 3 per cent.
Serum tumour necrosis factor alpha and insulin resistance in gastrointestinal cancer
Authors: McCall J L , Tuckey J A , Parry B R
Published: March 2007

Cancer cachexia may be mediated by endogenous peptides such as tumour necrosis factor alpha (TNF-α). Insulin resistance occurs in these patients, and is also seen experimentally with TNF-α administration. In this study, insulin sensitivity and energy metabolism were measured in 11 patients with gastrointestinal cancer and ten controls, using the euglycaemic glucose clamp and indirect calorimetry. Patients with cancer were significantly more insulin resistant than controls (P < 0.01) and in such patients insulin resistance correlated with serum TNF-α level (rs = 0.74, P < 0.01). Fasting insulin levels also correlated inversely with insulin sensitivity (rs = −0.62, P = 0.003). These results suggest a possible association between endogenous TNF-α production and insulin resistance in patients with gastrointestinal cancer.
Intraoperative colonoscopy in patients with colorectal cancer
Authors: Brullet E , Montané J M , Bombardó J , Bonfill X , Noguè M , Bordas J M
Published: March 2007

Sixty-seven patients underwent intraoperative colonoscopy during elective surgery for colorectal cancer. Complete examination of the colon was achieved in 65 patients (97 per cent), albeit with insertion through a colotomy in three (4 per cent). A synchronous carcinoma was found in six patients (9 per cent), which necessitated a change of planned surgical procedure. Synchronous polyps were detected and removed in 24 patients (36 per cent); two had polyps with carcinoma in situ. The mean age of patients with synchronous carcinoma was significantly higher than that of those without (74.1 versus 61.2 years, P = 0.02). Intraoperative colonoscopy took a mean of 15 min surgical time and only two minor complications (serosal lacerations) were encountered. In patients with colorectal cancer, intraoperative colonoscopy allows complete assessment of the colon and identifies synchronous lesions.
Intraoperative streptokinase: A useful adjunct to balloon-catheter embolectomy
Authors: Beard J D , Nyamekye I , Earnshaw J J , Scott D J A , Thompson J F
Published: March 2007

Intraoperative thrombolysis was attempted in 31 acutely ischaemic legs after operative arteriography had demonstrated residual distal thrombus or occlusion following balloon-catheter thromboembolectomy. There were 30 patients, 16 men and 14 women, aged 43–82 (median 73) years. The indication for operation was severe ischaemia with sensorimotor loss in 25 limbs, failed percutaneous thrombolysis in three and acute graft occlusion in three. A total of 21 perfemoral, 11 perpopliteal and four graft embolectomies were initially performed. Following arteriography, 100 000 units streptokinase was infused down the isolated distal arterial tree over 30 min and arteriography repeated. Complete lysis was achieved in 11 legs (35 per cent) and partial lysis in 12 (39 per cent). Additional procedures required included six operative angioplasties and six bypass grafts. After operation pedal pulses were restored in 14 limbs (45 per cent), with a viable leg in 23 cases (74 per cent) at the time of patient discharge or death. There were five wound haematomas but no evidence of systemic fibrinolysis. Four amputations were required, none in the group undergoing successful lysis, and there were seven deaths, five from cardiac disease. Arteriography after balloon-catheter embolectomy is essential to detect residual thromboembolus and intraoperative streptokinase appears to be a safe and effective way of removing this.
Choice of agent for peripheral thrombolysis
Authors: Earnshaw J J , Scott D J A , Horrocks M , Baird R N
Published: March 2007

Evidence has been accumulating that tissue plasminogen activator (tPA) is a more rapid and effective agent than streptokinase for peripheral thrombolysis. Twenty-three patients with acute limb-threatening ischaemia treated with tPA (0.5 mg h−1) over 15 months were compared with 20 consecutive patients previously receiving streptokinase (5000–10000 units h−1). There were no major differences between the rates of complete and partial lysis (61 per cent for tPA versus 65 per cent for streptokinase) or limb salvage (65 versus 55 per cent respectively). Complication rates were also similar. It was not possible to show that tPA, an agent ten times more expensive than streptokinase, was superior for peripheral thrombolysis.
Myocardial infarction after reconstruction of the abdominal aorta
Authors: Kalra M , Charlesworth D , Morris J A , Al-Khaffaf H
Published: March 2007

The records of 555 patients who underwent elective abdominal aortic reconstruction were analysed to identify risk factors predisposing to cardiac complications. Perioperative myocardial infarction occurred in 35 patients (6·3 per cent), of whom 12 (2·2 per cent) died. Using multiple logistic regression, four preoperative factors that were independently predictive for postoperative myocardial infarction were identified with the following relative risk ratios: history of transient ischaemic attacks, 5·08; raised serum creatinine level, 3·66; age >60 years, 3·00; and angina requiring regular treatment, 2·74. A scoring system using these four factors was devised that identified 150 of the 555 patients as at high risk, and included 69 per cent of those with myocardial infarction after operation and 83 per cent of those who died. A clinical risk score is a practical first step in identifying patients at risk of myocardial infarction; it would also reduce the number of patients for whom sophisticated tests of cardiac function were necessary.
Ankle fracture is associated with prolonged venous dysfunction
Authors: Tierney S , Burke P , Fitzgerald P , O'sullivan T , Grace P , Bouchier-Hayes D
Published: March 2007

Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d) EVF, 18·2(12·1) versus 55·9(19·5) percent, and increase in RVF, 87·0(14·3) versus 42·5(22·2) per cent (both P < 0·001). Analogous values were similar at 6 weeks, EVF 28·5(21·2) versus 55·6(21·9) per cent, RVF 82·2(16·8) versus 48·5(23·8) per cent (both P < 0·001), and at 12 weeks, EVF 39·1(16·0) versus 60·3(14·9) per cent, RVF 64·7(18·8) versus 38·8(13·2), per cent (both P < 0·001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture.
Parathyroidectomy in the treatment of patients with chronic renal failure: A 10-year review
Authors: Bessell J R , Proudman W D , Parkyn R F , Disney A P S
Published: March 2007

The technique and outcome of surgery for the manifestations of secondary hyperparathyroidism are described. Forty-seven patients were analysed retrospectively over a 10-year period. Total parathyroidectomy and autotransplantation to the forearm was performed in all but five patients. Improvement occurred in 87 per cent of patients and there were no graft failures. Of six deaths, none was related to surgery. Four patients had recurrent hyperparathyroidism, three being graft dependent and one requiring re-exploration of the neck. Total parathyroidectomy and autotransplantation is a safe and effective approach. The major management problem was graft hyperplasia, seen in three of the 47 patients and managed by simple excision.
Cholecystectomy and oesophageal reflux: A prospective evaluation
Authors: Jazrawi S , Walsh T N , Byrne P J , Hill A D , Li H , Lawlor P , Hennessy T P J
Published: March 2007

The effect of cholecystectomy on oesophageal function was examined prospectively. Of 37 patients studied, 17 (46 per cent) were still symptomatic 3–4 months after surgery. Thirteen patients (35 per cent) had abnormal oesophageal pH profiles before cholecystectomy, increasing to 27(73 per cent) afterwards(P < 0·002). The mean(s.e.m.) DeMeester acid reflux score increased from 15·2(2·1) to 34·2(5·2) (P < 0·001) after operation. Lower oesophageal sphincter function, as measured by the sphincter function index, was significantly reduced in the patients with abnormal pH profiles after operation (P < 0·01). Mean(s.e.m.) supine gastric alkaline shift (proportion of time at pH > 4) increased from 9·2(2·0) to 17·7(3·7) per cent (P < 0·02) and the incidence of gastritis from eight patients (22 per cent) to 23 (62 per cent) (P < 0·001). These data suggest that cholecystectomy results in gastro-oesophageal reflux that appears to be related to compromised sphincter competence.
Gastric remnant cancer as a metachronous multiple lesion
Authors: Furukawa H , Iwanaga T , Hiratsuka M , Imaoka S , Ishikawa Kabuto O T , Sasaki V , Kameyama M
Published: March 2007

The pathological characteristics and natural history of 35 gastric remnant cancers after partial gastrectomy for a malignant condition and 16 gastric cancers after gastrectomy for benign conditions were compared. Gastric remnant cancer following malignant disease was characterized by a well defined rather than diffuse appearance (in 43 versus 12 per cent of gastric remnant cancers after benign conditions, P < 0·05), location away from the anastomosis (83 versus 25 per cent, P < 0·05) and a shorter interval after the first operation (5–14 versus ≧ 20 years, P < 0·01). The 15- and 16-year survival rates appeared to be worse for gastric remnant cancer after malignant than after benign disease, but there was no statistically significant difference between the two groups in a generalized Wilcoxon test. In the former, direct invasion to adjacent organs was frequently observed. These findings suggest that gastric remnant cancer after gastrectomy for malignancy may be a metachronous multiple lesion, while that following benign disease may occur as a new cancer caused by the partial gastrectomy. To improve the survival of patients with cancer after gastrectomy for malignancy, a rational extended operation may be useful.
Nucleolar organizing regions in the opeerated rat stomach: Relationship to metaplasia, dysplasia and carcinoma
Authors: Seven R , Mercan S , Özarmaǧan S , Titlz I , Savci N , Doǧan Ö
Published: March 2007

This study investigated the role of duodenogastric reflux in rats after antecolic gastrojejunostomy. At the end of the study, adenocarcinoma was present in 43 per cent, dysplasia in 14 per cent and intestinal metaplasia in 43 per cent of animals. No such changes were found in control rats. A technique for silver staining nucleolar organizing regions (AgNORs) was applied to these lesions and to the control group. The AgNOR count gradually increased from normal gastric mucosa to carcinoma. This technique demonstrated differences in AgNOR count between normal mucosa and other lesions (adenocarcinoma, dysplasia, intestinal metaplasia) (P < 0·001). There was, however, considerable overlap among adenocarcinoma, dysplasia and metaplasia (P < 0·1).
Bacterial translocation in acute liver failure induced by 90 per cent hepatectomy in the rat
Authors: Wang X D , Soltesz V , Andersson R , Bengmark S
Published: March 2007

Bacterial infection and bacteraemia have been observed in patients with acute liver failure. The exact source of bacteria and nature of pathophysiological mechanisms explaining the development of infection remain unclear. In the present study, acute liver failure was induced by 90 per cent hepatectomy in the rat. The mesenteric lymph nodes and organs were harvested aseptically for bacteriological culture after sham operation or 90 per cent hepatectomy. Function of the liver and reticuloendothelial system (RES) was assayed; gut oxygen extraction was also measured. Translocation of enteric bacteria occurred 2 h after operation and increased with time following hepatectomy. Overgrowth of Escherichia coli in the distal small intestine started 2 h after operation. RES function decreased immediately after 90 per cent hepatectomy; uptake rates per gram tissue in other organs increased signicantly. These results indicate that bacterial translocation occurred early after 90 per cent hepatectomy, associated with a decrease in RES function and gut oxygen extraction, and overgrowth of intestinal bacteria.
Controlled liver splitting for transplantation in two recipients: Technique, results and perspectives
Authors: Houssin D , Boillot O , Soubrane O , Couinaud C , Pitre J , Ozier Y , Devictor D , Bernard O , Chapuis Y
Published: March 2007

A technique of controlled liver splitting for transplantation in two recipients is proposed, based on a full anatomical assessment of the graft including arteriography and cholangiography on the back-table. Using eight livers, 16 patients received a graft: right liver (eight patients), left lobe (four) or left liver (four). Twelve patients required urgent or very urgent transplantation. Anatomical assessment of the graft demonstrated a portal bifurcation in all cases, a common trunk of the left and middle hepatic veins in five, a right biliary duplication in three and duplication of the left branch of the middle hepatic artery in one. After revascularization of the graft, bleeding was greater in patients with a right graft, particularly if the middle hepatic vein had been ligated. The main postoperative complications were hepatic artery thrombosis (four cases), biliary complications (four), portal vein thrombosis (two), haematoma (two) and abscess (two). No primary non-function of the graft was observed. The postoperative survival rate was 75 per cent. The four patients in whom transplantation was not considered urgent are still alive. The immediate survival rate of the grafts was 69 per cent. These results compare favourably with those in the literature. In spite of the technical, logistical and ethical problems raised by this technique, the results suggest that controlled liver splitting for transplantation in two recipients may in the future significantly improve the feasibility of liver transplantation.
Management of traumatic liver injuries
Authors: Schweizer W , Tanner S , Baer H U , Lerut J , Huber A , Gertsch Ph , Blumgart L H
Published: March 2007

Liver injuries in Europe are usually caused by blunt trauma and a high mortality rate is generally reported. The severity of liver injury in 175 patients was graded from I to V and the Injury Severity Score assessed. Seventy-five patients in a prospective study (1987–1990) were treated according to a defined protocol. Non-operative management was used for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, liberal use of packing was made and a low threshold for relaparotomy employed. Increasing experience resulted in fewer indications for resection and a 40 per cent rate of non-operative treatment in the prospectively managed group. The overall mortality rate was 12 per cent (15 per cent in the retrospective and 8 per cent in the prospective group). Death in patients with multiple injuries should only rarely result from liver trauma.
Traumatic pancreatic pseudocysts
Authors: Lewis G , Krige J E J , Bornman P C , Terblanche J
Published: March 2007

Fifteen patients who developed pseudocysts following pancreatic trauma were evaluated to determine outcome in relation to the nature and site of pancreatic duct injury. Pseudocysts developed in eight patients operated on within 48 h of abdominal trauma and in seven who were initially treated conservatively. In none was duct injury diagnosed during initial management. Presentation was a median of 20 (range 8–360) days after injury. In 14 patients, pseudocysts (mean diameter 9 (range 3–16) cm) were confirmed by computed tomography or ultrasonography. Endoscopic retrograde pancreatography (ERP) demonstrated the site and severity of the duct injury in eight of 11 patients. Two patients with side duct injury on ERP were treated successfully without intervention. Pseudocysts arising from distal duct injuries (four patients) were treated by percutaneous aspiration or catheter drainage, although one patient required subsequent distal resection for recurrent pancreatitis caused by a pancreatic duct stricture. Three patients with duct injuries in the neck or body with pancreatic disruption underwent distal pancreatectomy. Proximal duct injuries with mature pseudocysts (three patients) were drained internally. Three patients had complicated pseudocysts (haemorrhage in one, sepsis in two) that necessitated emergency laparotomy and external drainage; one of these patients died from sepsis. These findings suggest that traumatic pancreatic pseudocysts that follow peripheral duct injury may resolve spontaneously, whereas those associated with distal duct injuries can be treated by percutaneous aspiration or catheter drainage. Proximal duct injuries, however, require surgical intervention using either resection or internal drainage, depending on the maturity of the cyst wall.
Effect of anorectal eversion during restorative proctocolectomy on anal sphincter function
Authors: Lewis W G , Holdsworth P J , Sagar P M , Blandy J P , Holmfield J H M , Johnston D
Published: March 2007

Twenty-six patients underwent restorative proctocolectomy with end-to-end ileal pouch—anal anastomosis, without resection of the anal mucosa, by the eversion technique. Before surgery patients underwent tests of anorectal function. These were repeated a median of 8 (range 3–21) months after operation. The median (range) maximum resting anal pressure was 93 (36–149) cmH2O before and 71 (40—131) cmH2O after operation (P = 0·002). The median (range) maximum squeeze pressure before operation was 136 (73—280) cmH2O; it was 149 (69—290) cmH2O afterwards (P  not significant). The median (range) length of the anal sphincter was 3·5 (2·5—4·5) cm before and 3·5 (2·0—4·5) cm after operation (P  not significant). Thresholds for sensation in the upper, middle and lower thirds of the anal canal before and after operation were, respectively, 8·7 versus 8·7, 6·8 versus 7·4 and 4·2 versus 6·2 mA (P not significant). All 26 patients were continent, although one experienced minor leakage. Function of the anal sphincter is not significantly impaired by eversion of the rectum and anus during restorative proctocolectomy.
Pancreatic infection complicating acute pancreatitis
Authors: Widdison A L , Karanjia N D
Published: March 2007

Pancreatic infection is the leading cause of death from acute pancreatitis. Patients with severe necrotizing pancreatitis are most at risk. Early computed tomography and percutaneous fine-needle aspiration microbiology of areas of pancreatic necrosis enable early diagnosis. Pancreatic infection should be treated surgically, although sterile necrosis may be managed conservatively. The role of antimicrobial drugs is uncertain.
Intermittent claudication incites systemic neutrophil activation and increased vascular permeability
Authors: Hickey N C , Hudlicka O , Gosling P , Shearman C P , Simms M H
Published: March 2007

Reperfusion following severe ischaemia incites a systemic response involving neutrophil activation and vascular injury. Recent work suggests that intermittent claudication may also be capable of inducing similar changes, reversible by revascularization. This observation may have implications for the treatment of claudication and explain the high associated cardiovascular mortality. This hypothesis was investigated using an in vivomodel. Rats underwent repeated hindlimb stimulation after common iliac artery ligation. Intravital fluorescence microscopy was used to observe postcapillary venules of the tibialis anterior muscle in the hindlimb. This revealed a bilateral increase in leucocyte–endothelial adhesion and vascular permeability to albumin after unilateral subtotal ischaemia and muscle stimulation, associated with increased urinary albumin excretion. These results provide further evidence supporting the association of intermittent claudication with potentially deleterious systemic manifestations.
Interventional radiology in the maintenance of infrainguinal vein graft patency
Authors: London N J M , Sayers R D , Thompson M M , Naylor A R , Hartshorne T , Ratliff D A , Bell P R F , Bolia A
Published: March 2007

The impact of interventional radiology on the cumulative patency rate of 112 consecutive infrainguinal vein grafts was reviewed. The primary. primary assisted and secondary cumulative patency rates at 42 months were 40, 65 and 69 per cent respectively. The difference between primary and primary assisted patency rates (40 versus 65 per cent, P = 0·001) resulted from the early detection and treatment of stenoses in 30 grafts by percutaneous transluminal angioplasty (PTA). Interventional radiology also improved the cumulative graft patency rate through PTA of one inflow and five outflow arteries, thrombolysis of two graft occlusions, embolization of two persistent arteriovenous fistulas and salvage of one graft on the first day after operation by percutaneous aspiration of distal graft thrombus. Interventional radiology has a crucial role to play in the maintenance of infrainguinal vein graft patency; provided that graft stenoses are detected early in their development by aggressive graft surveillance, PTA is a highly effective treatment.
Survey of minor surgery in general practice in the West of Scotland
Authors: Morrison J M , Murray T S
Published: March 2007

Since April 1990 certain minor surgical procedures have attracted an item-of-service payment for general practitioners (GPs). A postal survey was undertaken to obtain information about minor surgery in general practice in the West of Scotland and to find out whether further postgraduate education is required in this field. From a random stratified sample of 356 GPs, 311 (87·4 per cent) responded. Practitioners on health board minor surgery lists have increased minor surgery activity since April 1990; they prefer to perform the less technically demanding and time-consuming procedures on the eligible list. It is concluded that there is scope for increasing postgraduate education in minor surgery for GPs.
Changes in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery
Authors: Wakefield C H , Carey P D , Foulds S , Monson J R T , Guillou P J
Published: March 2007

Expression of class II major histocompatibility complex (MHC) on monocytes is a prerequisite for effective antigen presentation and processing, an important component of the immune response to infection. It has been reported that the level of monocyte class II expression may identify patients who go on to develop infective complications following trauma. In the present study, flow cytometry was used to measure MHC class II (human leucocyte antigen (HLA)-DR) expression on circulating monocytes and T cells in 36 patients undergoing elective major resectional surgery, of whom 12 developed septic complications. The percentage of HLA-DR positive monocytes fell significantly on the first day after operation in both groups (P <0·0001) but was significantly higher in those without than in those with sepsis on days 1, 3 and 5 (P <0·05). In contrast, the level of T cell HLA-DR expression rose significantly on the first day after operation (P <0·05) in patients without sepsis to a level higher than in those who developed infection (P <0·05). These findings have important implications, as predictive biological elements and for biological response modification, in patients at risk of developing sepsis after surgery.
Use of an accident and emergency department observation ward in the management of head injury
Authors: MacLaren R E , Ghoorahoo H I , Kirby N G
Published: March 2007

The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. An accident and emergency observation ward was open on weekdays only; at weekends, patients with head injury were admitted to a general surgical ward. When the observation ward was open, 51 of the 76 patients (67 per cent) presenting with admission criteria were admitted. When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.