bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colonoscopic surveillance after curative resection for colorectal cancer
Authors: Patchett S E , Mulcahy H E , O'Donoghue D P 
Published: March 2007

Abstract
Colonoscopic surveillance after resection for colorectal cancer has been advocated to improve detection of anastomotic recurrence, and of synchronous and metachronous tumours. The benefit provided by colonoscopy remains unproven, and the best timing of examination is unclear. To determine the value of colonoscopy after curative resection for large bowel cancer, the efficacy of an endoscopic surveillance programme in the early detection of intraluminal bowel recurrence in a series of patients admitted with colorectal cancer was examined. Between April 1983 and December 1988, 132 patients underwent colonoscopy. Eight (6·1 per cent) were found to have intraluminal recurrence without evidence of extraluminal spread. Six of these recurrences were at the site of anastomosis and two represented metachronous tumour development. All of these patients were symptomatic at the time of diagnosis. In 15 patients (11·4 per cent), adenomatous polyps were discovered during the initial endoscopic examination. These results indicate that colonoscopic surveillance will rarely allow early detection of asymptomatic intraluminal bowel recurrence, but is valuable in the detection of synchronous lesions. Frequent surveillance is not justified in the early postoperative years and colonoscopy should probably be confined to a single procedure to exclude synchronous lesions.
Hepatocyte growth factor/scatter factor, liver regeneration and cancer metastasis
Authors: Jiang W G , Hallett M B , Puntis M C A 
Published: March 2007

AbstractHepazocyte growth factor (HGF) is the most potent stimulator of hepatocyte growth and DNA synthesis identified; it is now known to be the same molecule as scatter factor, which increases the motility of a variety of cell types. HGF is becoming recognized as one of the most important factors in the regulation of liver regeneration after surgical resection or chemical damage. HGF is produced by several tissues, including neoplasms; it can therefore provide a stimulus for increased motility of malignant cells by both a paracrine and autocrine mechanism. The receptor for HGF has been identified as the product of the oncogene c-met, raising the possibility that this gene plays a key role in facilitating cellular invasion. HGF may therefore be important not only for liver cell growth but also in metastasis. This article summarizes the current position of research on HGF, and presents both clinical and scientific evidence that strongly implicates this factor in liver regeneration and cancer invasion and metastasis.
Significance of circumferential resection margin involvement after oesophagectomy for cancer
Authors: Sagar P M , Johnston D , McMahon M J , Dixon M F , Quirke P 
Published: March 2007

Abstract
This study examined the influence of tumour involvement of the circumferential resection margin on subsequent local recurrence after oesophagectomy. Fifty patients were studied: 36 men and 14 women of median age 62 (range 44–83) years. Each patient had undergone oesophagectomy at which all macroscopic disease had been removed. Pathological specimens were sectioned tangentially at 0·5–1·0-cm intervals to permit microscopic examination of the circumferential resection margin. Patients were followed and investigated by endoscopy with biopsy and imaging techniques only if symptomatic. Twenty of the 50 specimens demonstrated involvement of the circumferential resection margin. At median follow-up of 36 (range 24–52) months, eleven of these 20 patients had developed histologically proven local recurrence compared with only four of the remaining 30 in whom the resection margin was clear of tumour (P &lt; 0·01). Circumferential spread of oesophageal cancer appears to be a significant cause of local tumour recurrence.
CD4 and CD8 monoclonal antibody therapy: Strategies to prolong renal allograft survival in the dog
Authors: Watson C J E , Cobbold S P , Davies H F S , Rebello P R U B , Waldmann H , Calne R Y , Metcalfe S M 
Published: March 2007

Abstract
The value of CD4 and CD8 monoclonal antibody therapy in tolerance induction has been demonstrated in rodent transplant models. In this paper the immunosuppressive potential of CD4 and CD8 monoclonal antibodies for dog renal allografts was evaluated as a preliminary to tolerogenic studies in this large animal model. Monoclonal antibodies were given for a maximum of 10 days after transplantation. Therapy was stopped prematurely following adverse reactions associated with the recipient developing an antibody response against the foreign (rat) therapeutic monoclonal antibody. Blood trough levels of CD4 and CD8 antibodies indicated that saturating doses were achieved. Although neither CD4 nor CD8 alone prolonged allograft survival (rejection by day 7), combination of CD4 and CD8 antibodies resulted in good graft function for a median of 14 days. The effect of removing circulating T lymphocytes was also assessed using a lytic Thy-1 monoclonal antibody. Alone Thy-1 had little effect but, when combined with CD4, the median allograft survival time was increased to 15.5 days. Reduction of the number of circulating T lymphocytes appears complementary to blockade of CD4 for immunosuppression, while blockade of CD4 combined with removal of CD8 also favours allograft survival.
Patient selection and timing of dynamic computed tomography in acute pancreatitis
Authors: Lucarotti M E , Virjee J , Alderson D 
Published: March 2007

Abstract
Dynamic computed tomography (CT) is the most accurate method for determining the extent of necrosis in acute pancreatitis. Debate exists, however, regarding patient selection and the optimal timing of CT. This study examined selection based on biochemical and/or clinical criteria and the influence of delayed dynamic CT performed 5–10 days after the onset of an attack. A total of 120 patients with acute pancreatitis were studied. Dynamic CT was performed if any of the following criteria were identified: a biochemically severe attack (according to Glasgow criteria) in the first 24 h, C-reactive protein (CRP) level above 120 mg/l in the first 3 days or failure of clinical resolution within 7 days. Of 42 patients selected for CT, five died from multisystem organ failure before day 5. There were no deaths or delayed complications in the 78 patients. not selected for scanning. Positive Glasgow criteria alone in the scanned group had a sensitivity for predicting necrosis (as recognized by CT) of 22 per cent and a specificity of 20 per cent. Measurement of CRP level alone had a sensitivity of 26 per cent and specificity of 80 per cent. Failure of clinical resolution had a sensitivity of only 7 per cent but a specificity of 100 per cent. The combination of Glasgow criteria and CRP level had a sensitivity of 44 per cent and specificity of 100 per cent. Delayed complications (pseudocyst, five; infection, six) occurred only in patients with necrosis, and there were two deaths. An ‘at-risk’ group can be identified for CT on the basis of biochemical and clinical observations. Neither routine nor emergency dynamic CT in acute pancreatitis seems justified.
Correlation between p53 mutations and antibody staining in breast carcinoma
Authors: Dunn J M , Hastrich D J , Newcomb P , Webb J C J , Maitland N J , Farndon J R 
Published: March 2007

Abstract
Abnormalities of the p53 gene and protein were examined in 81 primary breast carcinoma samples. Using a polymerase chain reaction–single-strand conformational polymorphism (PCR—SSCP) analysis, mutations in p53 exons 5–8 were identified in 13 of 81 tumours (16 per cent) and confirmed by DNA sequencing. Positive staining for p53 protein was detected in ten of 77 (13 per cent) of these tumours using polyclonal CM1 antibody on formalin-fixed tissue. Mutations detected by PCR—SSCP analysis were more common in grade III tumours (P = 0·015), but no correlation was found with tumour size, node status or level of epidermal growth factor receptor expression. A p53 mutation was associated with positive antibody staining in only two patients. Positive immunohistochemical staining using a p53 antibody may detect p53 protein expression, but this may not correlate directly with an underlying mutation in the hot spot region examined.
Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract
Authors: Steele R J C 
Published: March 2007

AbstractIn a 4-year period, 100 anastomoses in the upper gastrointestinal tract were fashioned using a single serosubmucosal layer of continuous polydioxanone. One patient required revisional surgery because of anastomotic stricture after partial gastrectomy, but there was no other complication related to the anastomosis. This technique is simple, safe and quick to perform.
Native and graft pancreatitis following combined pancreas—renal transplantation
Authors: Fernández-Cruz L , Sabater L , Gilabert R , Ricart M J , Saenz A , Astudillo E 
Published: March 2007

Abstract
Ten patients who had undergone whole-organ pancreas transplantation and pancreatoduodenocystostomy from a total of 60 simultaneous cadaveric kidney—pancreas transplants met the criteria for graft pancreatitis. This condition is clearly different from acute rejection on the basis of marked hyperamylasaemia and significant local findings over the allograft. Graft rejection was the cause of graft loss in one of the patients; eight are alive, seven with a functioning graft 61, 30, 27, 25, 21, 18 and 14 months after transplantation. Two patients died: one from severe graft pancreatitis and the other from cytomegalovirus infection. Bladder drainage with or without antibiotics has been the most common therapy, based on the theory that damage is caused by duodenal content and infected urine reflux. To prevent graft loss, antiviral treatment should be given when pancreatitis due to cytomegalovirus is suspected or diagnosed. Two patients with native pancreatitis are also described; the disease was severe and surgery was required in both cases. The pancreas grafts have now been functioning for 2 years 7 months and 2 years 10 months respectively.
Changing trends in the management of extrahepatic cholangiocarcinoma
Authors: Guthrie C M , Haddock G , De Beaux A C , Garden O J , Carter D C 
Published: March 2007

Abstract
A series of 107 patients with cholangiocarcinoma diagnosed between January 1980 and December 1991 is reported. Changing patterns of investigation and treatment in the periods 1980–1985 and 1986–1991 are analysed. There was a decrease in the use of percutaneous transhepatic cholangiography in the second period (86 versus 51 per cent of patients) but increased use of endoscopic retrograde cholangiography (19 versus 71 per cent) and computed tomography (8 versus 59 per cent). The overall resectability rate (17 per cent) was similar to those of other reported series but greater in the second period (8 versus 21 per cent). Palliation by endoscopic and percutaneous stenting was associated with a high incidence of recurrent cholangitis (55 per cent) and jaundice (35 per cent). During the second 6-year period, more effective palliation was achieved by segment III cholangiojejunostomy with a lower incidence of recurrent cholangitis (19 per cent) and jaundice (19 per cent). Overall prognosis for patients with this condition is grim and efforts must usually be aimed at providing the most appropriate palliation.
Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis
Authors: Shirai Y , Tsukada K , Kawaguchi H , Ohtani T , Muto T , Hatakeyama K 
Published: March 2007

Abstract
The effectiveness and long-term results of percutaneous cholecystostomy for acute acalculous cholecystitis are evaluated. Fifteen patients with acute acalculous cholecystitis were treated prospectively by this procedure, using a pigtail catheter successfully placed under ultrasonographic and fluoroscopic guidance. Prompt relief of the signs and symptoms of cholecystitis was achieved in 14 patients. One required emergency cholecystectomy for uncontrolled bleeding after drainage. Another patient underwent prophylactic cholecystectomy before further chemotherapy for leukaemia. The remaining 13 patients required no further surgery. Morbidity and mortality rates were 13 per cent and nil respectively. Long-term follow-up showed no recurrence of cholecystitis after removal of the catheter. Percutaneous cholecystostomy is a safe, effective and usually definitive procedure for the treatment of acute acalculous cholecystitis.
Factors influencing the hyperaemic response after carotid endarterectomy
Authors: Naylor A R , Whyman M R , Wildsmith J A W , McClure J H , McL. Jenkins A , Merrick M V , Ruckley C V 
Published: March 2007

Abstract
Transcranial Doppler ultrasonography was used to evaluate serially the changes in middle cerebral artery blood flow velocity (MCAV) in 37 consecutive patients during the first 72h after carotid endarterectomy to identify factors that may predispose towards postoperative hyperaemia. Within 6 h of endarterectomy, median MCAV in the operated hemisphere was 48 per cent (95 per cent confidence interval 37–60 per cent) above that on admission and remained 27 per cent (95 per cent confidence interval 19–37 per cent) higher at 72h. There was a similar, but less marked, increase in MCAV in the contralateral middle cerebral artery during the same time period. There was no association between the postoperative increase in MCAV and clinical presentation, admission MCAV, the presence or absence of a residual neurological deficit or infarction on computed tomography before operation, carotid clamp time, shunt usage, internal carotid artery stump pressure or MCAV during clamping. The greatest increase in MCAV was observed in patients with internal carotid artery stenosis ⩾ 50 per cent and, more particularly, in those with preoperative evidence of impaired cerebrovascular reserve. In the latter patients, MCAV was 100 per cent above the admission level within 12 h of operation and was still 50 per cent raised at 72 h.
Randomized controlled trial of patch angioplasty for carotid endarterectomy
Authors: Ranaboldo C J , D'sa A A B Barros , Bell P R F , Chant A D B , Perry P M 
Published: March 2007

Abstract
A randomized controlled trial was performed to evaluate patch angioplasty for patients undergoing carotid endarterectomy. There were 213 patient episodes affecting 148 men and 65 women, with 109 allocated to patch angioplasty. Following surgery six patients suffered transient ischaemic attacks but these did not delay discharge from hospital. Six individuals (four patched operations, two not patched) required re-exploration for postoperative haemorrhage and eight (two patched procedures, six not) had potentially serious neurological problems after operation. Of these eight patients, four (none receiving patch angioplasty) underwent re-exploration and in each case a clot was removed and a patch inserted; three of the four made a good long-term recovery. The other four patients suffered completed strokes from which one died. Two further patients (one patched procedure, one not) died after operation from myocardial events, giving an overall 30-day stroke or mortality rate of 2·8 per cent. Objective follow-up assessment with duplex scanning at 1 year was completed by 94·8 per cent of patients; significantly more vessel restenoses and occlusions were observed in those not receiving patches (P &lt; 0·01). Patch angioplasty reduces the number of immediate postoperative complications, and significantly lowers vessel restenosis and occlusion rates at 1 year after operation.
Short myotomy for vigorous achalasia
Authors: Paricio P Parrilla , Martinez de Haro L F , Escandell A Ortiz , Cuenca G Morales , Martinez J Molina 
Published: March 2007

Abstract
Vigorous achalasia has been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the whole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients with vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS) were analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or good in all cases. Surgery induced a significant decrease (P &lt; 0·01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be treated surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.
Prognostic value of DNA ploidy in primary gastric leiomyosarcoma
Authors: Suzuki H , Sugihira N 
Published: March 2007

Abstract
The prognostic value of DNA ploidy was evaluated in 25 patients with primary gastric leiomyosarcoma, using paraffin-embedded archival specimens analysed by DNA flow cytometry. Ploidy patterns were diploid in ten tumours and non-diploid in 15. They did not correlate with clinicopathological features of the lesions such as tumour size and grade or mitotic index. A non-diploid pattern was associated with a significantly reduced patient survival rate (P &lt; 0·05), as was higher tumour grade (P &lt; 0·01). Neither tumour size nor mitotic index correlated with patient survival.
Repeat hepatectomy for cancer
Authors: Elias D , Lasser Ph , Hoang J M , Leclere J , Debaenet B , Bognel C , Spencer A , Rougier Ph 
Published: March 2007

Abstract
In a series of 279 hepatectomies performed for cancer between June 1984 and March 1992, 46 were repeat operations, for metastases in 41 patients. The primary tumour was in the colon and rectum (28 patients), APU Doma (five) and miscellaneous (eight). Repeat hepatectomies were performed in 26 per cent of patients who had recurrence after the first liver resection and in 40 per cent of those who had liver recurrence. An unsuspected extrahepatic recurrence was discovered and resected in eight instances and in two other cases a known extrahepatic recurrence was resected during the second hepatectomy. The hospital mortality rate was 2 per cent (one patient); the death was from nosocomial pneumonia. The total morbidity rate including minor complications was 32 per cent, with a higher frequency of haemorrhagic problems after secondary liver resection (12 per cent) than after primary hepatectomy (5 per cent). The rate of postoperative complications after repeat hepatectomy was related significantly to operative blood loss greater than 1500 ml(P = 0·04). The technical problems of repeat hepatectomy were: (1) re-exposure of the liver, considered to be difficult in 67 per cent of second liver resections and 80 per cent of third procedures; (2) the liver parenchyma, which often had histological modifications between first and second resections and was more difficult to ‘work’ as shown by the mean duration of clamping of the hepatic pedicle (54 min for secondary versus 36 min for primary liver resection); and (3) modification of the intraparenchymal vasculobiliary anatomy following liver regeneration after major hepatectomy. Intraoperative ultrasonography was of great benefit. Rates of crude and recurrence-free survival were relatively encouraging at 47 and 33 per cent 3 years after the second liver resection for the whole group. These values were lower for colorectal cancer (37 and 21 per cent 3 years after the second hepatectomy). These figures do not, however, convey the complete picture of the outcome for these patients. During the same follow-up period, 143 recurrences were detected and a mean of 2·9 resections per patient were performed. The indications for repeat hepatectomy are still to be clarified, although the surgical technique is safe.
Haemostasis after partial hepatectomy using argon beam coagulation
Authors: Postema R R , Plaisiert P W , Ten Kate F J W , Terpstra O T 
Published: March 2007

Abstract
The argon beam coagulator is a new device for haemostasis during and after surgery on parenchymatous organs. No data are available on its efficacy and tissue effect following hepatic resection. Blood loss, the time needed to achieve adequate haemostasis and histological findings after liver resection were assessed in 12 pigs using argon beam coagulation or suture ligation only, the mattress suture technique and tissue glue application. The treatment was randomly assigned to each of the four liver lobes in each pig. Median blood loss following argon beam coagulation was 13 (range 2–47) ml and after simple suture ligation 55 (range 2–260) ml (P &lt; 0·02). The median time needed for adequate haemostasis following argon beam coagulation was 3 (range 2–7) min versus 14 (range 2–48) min in the control group (P &lt; 0·005). There was no difference between argon beam coagulation and tissue glue, which were both superior to the use of mattress sutures. Argon beam coagulation resulted in less tissue damage than tissue glue or mattress suturing. The argon beam coagulator is an efficient device for achieving haemostasis following partial hepatectomy in the pig. It causes only a moderate tissue reaction.
Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy
Authors: Cuesta M A , Meijer S , Borgstein P J , Mulder L Sibinga , Sikkenk A C 
Published: March 2007

Abstract
Despite the advances made since the introduction of ultrasonography, computed tomography and magnetic resonance imaging, a wide discrepancy may occur between preoperative and peroperative staging of gastrointestinal malignancy with liver and peritoneal metastases. Diagnostic laparoscopy performed immediately before a planned laparotomy can provide valuable information for the accurate assessment and appropriate management of some forms of gastrointestinal malignancy, especially that of the liver and pancreas. For evaluation of small liver and retroperitoneal malignancies, intraoperative ultrasonography performed by laparotomy is of proven value. It is now technically possible to perform ultrasonography through a laparoscopic cannula using high-resolution ultrasonographic transducers. This combination of laparoscopy and ultrasonography was studied in 25 patients with established liver lesions, carcinoma of the gallbladder or pancreatic cancer. Additional information leading to a change in surgical approach was obtained in 20 patients. Laparoscopic ultrasonography, although still in a preliminary phase of development, is a simple and reliable technique that will contribute to more accurate staging of intra-abdominal malignancy.