bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategy for management of distal ileal Crohn's disease
Authors: Andrews H A , Keighley M R B , Alexander-Williams J , Allan R N 
Published: March 2007

Abstract
We have determined the outcome of a defined policy for the management of distal ileal Crohn's disease using a prospective computer-based analysis of 139 patients diagnosed between 1970 and 1988 with a mean follow-up of 10 years. The policy in outline consists of conservative treatment for acute obstructive episodes, resection or strictureplasty for recurrent obstructive episodes, surgical treatment for abscess and fistula formation and specific medical treatment (corticosteroids, immuno-suppressive therapy or metronidazole) for symptomatic non-obstructive disease. Twenty-nine patients had a benign course without resection. The remainder were treated surgically at some time but only 28 of these patients had specific treatment before operation. Thirty-three needed more than one resection and five needed more than three surgical procedures. Immediate, early or delayed surgical treatment did not affect the reoperation rates or the long-term outcome. Eleven patients died, ten of causes unrelated to Crohn's disease. Of the 128 living patients, 114 are fit and well, and only two are currently taking specific medication. Fourteen are unwell of whom six either need or have refused further surgery which could restore them to good health. This management policy has achieved excellent long-term results in nearly all patients, and our findings suggest that the timing of surgery and its nature are more important in determining outcome than specific medical therapy.
Perineal excision of the rectum for prolapse in the elderly
Authors: Finlay I G , Aitchison M 
Published: March 2007

Abstract
A perineal operation is described for the treatment of rectal prolapse. The surgery improves functional outcome by correcting the anatomical anomalies associated with the condition. In 17 elderly women, there was one perioperative death and one recurrence. At a median follow-up of 24 months, 13 patients were able to control solid stool and three were profoundly incontinent. The operation may be an alternative to the more invasive abdominal procedures for the treatment of the majority of patients with prolapse.
Relationship between outlet obstruction constipation and obstructed urinary flow
Authors: MacDonald A , Shearer M , Paterson P J , Finlay I G 
Published: March 2007

Abstract
Ten women with symptoms and radiological features of outlet obstruction constipation underwent urodynamic bladder studies. The results were compared with ten age- and sex-matched controls. The mean(s.e.m.) peak flow rate for patients was 19·4(6·4) ml/s compared with 32·1(7·2) ml/s for controls (P&lt;0·05). The mean(s.e.m.) voiding time for patients was 62·9(23·7) s against a corresponding value of 15·6(6) for controls (P&lt;0·05). The mean(s.e.m.) bladder volume in patients was 482(80) ml compared with a control value of 254(112) ml (P&lt;0·03). The mean residual volume was raised in patients at 45 ml (range 10–150 ml). The mean(s.e.m.) detrusor pressure during the voiding phase was 53·3(12) cmH2O. These results demonstrate that patients with outlet obstruction constipation have a generalized pelvic floor disorder resulting in obstructed urinary flow.
Evaluation of diagnostic peritoneal lavage in suspected penetrating abdominal stab wounds using a dipstick technique
Authors: Muckart D J J , McDonald M A 
Published: March 2007

Abstract
The total protein content (g/l) and white blood cell count (cells/mm3) of diagnostic peritoneal lavage was assessed using a urine dipstick in 46 patients with suspected penetrating abdominal stab wounds and equivocal physical examination. Those patients with a protein content ⩾ 1 g/l and white blood cell count of &gt;500 cells/mm3 were submitted to laparotomy while those with lower values underwent observation and repeat physical examination. In all, 26 patients had a positive lavage and significant injuries were found in 23 of these. Of 18 patients with a negative lavage, 17 were managed successfully without operation while one patient died from complications related to central venous catheterization. In two patients the lavage results were equivocal. One underwent a negative laparotomy and the remaining patient recovered uneventfully. The test has a 100 per cent sensitivity and 86 per cent specificity and provides an accurate, cheap, and rapid means of diagnosis of intra-abdominal injury in penetrating trauma.
Severe late postsplenectomy infection
Authors: Cullingford G L , Watkins D N , Watts A D J , Mallon D F 
Published: March 2007

Abstract
In all, 1490 patients underwent splenectomy in Western Australia between 1971 and 1983, giving 7825 person years exposure. Thirty-three patients developed severe late postsplenectomy infection (septicaemia, meningitis or pneumococcal pneumonia requiring hospitalization) and three developed overwhelming postsplenectomy infection. The incidence and mortality rates of severe late postsplenectomy infection were 0·42 and 0·08 per 100 person years exposure respectively and for overwhelming postsplenectomy infection the incidence and mortality rates were 0·04 per 100 person years exposure. There were 628 splenectomies after trauma, giving 3922 person years exposure. Eight patients developed severe late postsplenectomy infection of whom one had overwhelming postsplenectomy infection. Following trauma, the incidence of severe late postsplenectomy infection was 0·21 per 100 person years exposure, with the incidence and mortality rates of overwhelming postsplenectomy infection being 0·03 per 100 person years exposure. Patients undergoing splenectomy have a 12·6-fold increased risk of developing late septicaemia compared with the general population. Splenectomy following trauma gives an 8·6-fold increased risk of late septicaemia. The majority of severe late postsplenectomy infections did not occur within the first 2 years and 42 per cent of severe late postsplenectomy infections occurred &gt; 5 years after splenectomy. The low incidence of severe late postsplenectomy infection and overwhelming postsplenectomy infection makes statistical evaluation of the effectiveness of prophylactic antibiotics, vaccination and splenic repair most difficult.
Combined portal vein and liver resection for carcinoma of the biliary tract
Authors: Nimura Y , Hayakawa N , Kamiya J , Maeda S , Kondo S , Yasui A , Shionoya S 
Published: March 2007

Abstract
Twenty-nine patients with advanced carcinoma of the bile duct or gallbladder underwent combined portal vein and liver resection. Segmental excision of the portal vein was performed in 16 cases and wedge resection of the vessel wall in 13. The operative mortality rate was 17 per cent. The median survival for the 24 patients who left hospital was 19·8 months. Actuarial survival rates at 1, 3 and 5 years for all 29 patients were 48 per cent, 29 per cent, and 6 per cent respectively, whereas the median survival for 46 patients with unresectable carcinoma was 3 months and the 1 and 3-year actuarial survival rates were 13 per cent and zero respectively. This difference in survival times between patients undergoing hepatectomy with portal vein resection and those with unresectable carcinoma were statistically significant (P&lt;0·01). Combined portal vein and liver resection is recommended as a reasonable surgical approach in selected patients with advanced carcinoma of the biliary tract.
Intra-arterial streptokinase infusion in acute lower limb ischaemia
Authors: Scott D J A , Wyatt M G , Wilson Y G , Murphy P , Baird R N , Horrocks M 
Published: March 2007

Abstract
Between 1986 and 1988, 38 patients (29 men and nine women), median age 65 years (range 38–85 years), underwent local intra-arterial streptokinase therapy for acute lower limb ischaemia. Three patient groups were identified: 15 with acute on chronic ischaemia (group 1), 12 postangioplasty (group 2) and 11 postfemorodistal bypass (group 3). Distal arteriographic run-off was a significant discriminant between success and failure in group 1 (n = 15, χ2 = 11·5, P = 0·001) and in the overall group (n = 38, χ2 = 17·2, P&lt;0·001). In group 2, four patients with good run-off had an unsuccessful outcome; this was due in all cases to technical problems (haemorrhage in two and intimal dissection in two). In group 3, two patients with good run-off had unsuccessful streptokinase infusions. In both cases the graft failed in the early postoperative period (&lt;30 days). By contrast, the four patients whose grafts occluded after 30 days had successful streptokinase infusions and long-term graft patency was achieved by further surgery and balloon dilatation. In all groups, no patient with a poor run-off had a successful outcome following streptokinase administration. The role of local intra-arterial streptokinase therapy in the critically ischaemic limb remains controversial, but these results suggest that an adequate run-off is an important factor in the selection of patients for treatment.
Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy
Authors: Napoleon B , Pujol B , Berger F , Valette P J , Gerard J P , Souquet J C 
Published: March 2007

Abstract
Endosonography is the best available method for the pretherapeutic staging of rectal cancer. The present prospective study was to determine the influence of previous radiotherapy, widely used in the management of this tumour, on the accuracy of endosonography. A complete endosonographic examination was performed just before surgery in 40 patients with rectal cancer. Endosonographic and pathological staging were compared in group A, 21 patients without previous radiotherapy, and group B, 19 patients with preoperative radiotherapy. While the endosonographic accuracy for lymph node involvement was similar in the two groups (85 per cent compared with 84 per cent), wall invasion was correctly ascertained in 86 per cent in group A but in only 47 per cent in group B (P &lt; 0·05). After irradiation, the thickening of the rectal wall and the poor visualization of the hyperechoic layers hampered interpretation. Post-radiotherapy inflammation and/or fibrosis probably explained the echographic changes. Radiotherapy therefore altered endosonographic staging of rectal cancer. New interpretation criteria are needed for evaluation and follow-up of rectal cancer treated by radiotherapy.
Surgical anatomy of donor extended right trisegmentectomy before orthotopic liver transplantation in children
Authors: Tan K C , Malcolm G P , Reece A S , Calne R Y 
Published: March 2007

Abstract
Liver transplantation is now accepted as the treatment of choice for children with end stage liver disease. A major constraint has been the shortage of donor organs of appropriate size. The use of reduced size adult organs has partially alleviated this problem but the previous technique employed was limited to a donor:recipient body-weight disparity of not greater than 3:1. Recently a new technique has been described that allows safe transplantation with a donor:recipient weight ratio of greater than 10:1. This should greatly increase the paediatric donor pool. Anatomical landmarks and techniques necessary for donor reduction hepatectomy are described from the dissection of 50 adult cadaveric livers. Variations in all important biliary and vascular structures necessitated adjustments in operative technique.
Lymph node counts in the upper abdomen: Anatomical basis for lymphadenectomy in gastric cancer
Authors: Wagner P K , Ramaswamy A , Rüschoff J , Schmitz-Moormann P , Rothmund M 
Published: March 2007

Abstract
The number of regional lymph nodes was determined in sites relevant to lymphadenectomy in gastric cancer in 30 cadavers. Tissue was cleared by dissolving fatty tissue, thus making lymph nodes with a diameter of at least 1 mm visible. All lymph node stations indicated by the Japanese Research Society for Gastric Cancer were studied. In stations 1–11 (corresponding with R2 resection) an average of 27 nodes (range 17–44 nodes) was found, whereas stations 1–16 (corresponding with R3 resection) showed an average of 43 nodes (range 25–64 nodes). These values are higher than those usually obtained from lymphadenectomy for gastric cancer. Striking individual differences in the total number of lymph nodes and the number of single stations was observed. The number of lymph nodes in these investigations are the normal anatomical values and serve as quality control of lymph node dissection in gastric carcinoma.
Success and failure with neonatal tracheo-oesophageal anomalies
Authors: Goh D W , Brereton R J 
Published: March 2007

Abstract
In seven and a half years, one surgical team treated 67 consecutive neonates with oesophageal atresia and/or tracheo-oesophageal fistula. According to Waterston's classification, 28 were in group A, 12 in group B and 27 in group C. The mortality rate during the initial admission was 10 per cent, all seven deaths being unavoidable in infants in group C with multiple anomalies. Birthweight alone had no bearing upon the chances of survival. Primary oesophageal repair, including one suture-fistula procedure and one delayed primary repair, was attempted in 54 (84 per cent) of the 64 patients with atresia and was successful in 46 (85 per cent). All three H-type tracheo-oesophageal fistulae were successfully divided in infants in group A. Recurrent tracheo-oesophageal fistula developed in four (7 per cent) infants, one of whom (group A) underwent successful repair. One disrupted anastomosis was successfully resutured (group A), so an intact oesophagus was finally achieved in 51 patients, of whom six (12 per cent) developed anastomotic strictures and 21 (41 per cent) underwent surgery for gastro-oesophageal reflux. Of the 60 early survivors, 10 (17 per cent) underwent aortopexy for tracheomalacia. Whenever possible, primary repair is advocated in all infants. Even for those in group C with multiple, severe associated anomalies, the combined early and late mortality was no greater following primary repair (7 died of 12 operated) than after staged repair (4 died of 7 operated), but major anastomotic complications were more common in infants in group C (5 out of 19) than in those in groups A and B (3 out of 38).
Necrotizing fasciitis
Authors: Asfar S K , Baraka A , Juma T , Ma'Rafie A , Aladeen T , Al Sayer H 
Published: March 2007

Abstract
Ten cases of necrotizing fasciitis are reviewed. Three patients died but only two of these deaths were due to uncontrolled septicaemia. All isolated organisms were sensitive to a combination of piperacillin and ampicillin which we now regard as the initial antibiotic combination of choice. Prompt and aggressive surgical debridement remains the cornerstone of management.
Effect of fibrin glues on the mechanical properties of healing wounds
Authors: Byrne D J , Hardy J , Wood R A B , McIntosh R , Cuschieri A 
Published: March 2007

Abstract
Tissue glues are important in clinical practice. Fibrin based glues have many advantages over non-biological adhesives. The optimum formulation of these glues measured by their effect on mechanical properties of healing wounds has not been determined. Using a model involving standard dorsal skin incisions in adult male Wistar rats various glue formulations were compared by varying the fibrinogen, thrombin and factor XIII concentrations. Calcium (40 μmol/ml) and aprotinin (3000 kallidinogenase inactivator units, KIu/ml) concentrations were kept constant. Animals were killed at 8 days and wounds excised. Standard strips of these wounds were mechanically tested using an Instron tensiometer and the stress, strain, elasticity and work required to rupture wounds were calculated. Results indicate that a fibrin glue with a fibrinogen concentration of approximately 39 g/l and a thrombin concentration of 200–600 units/ml with no added factor XIII will result in wounds with significantly increased stress, energy absorption and elasticity values.
Autopsy-verified pulmonary embolism in a surgical department: Analysis of the period from 1951 to 1988
Authors: Lindblad B , Eriksson A , Bergqvist D 
Published: March 2007

Abstract
A retrospective analysis was undertaken of all surgical patients in Malmö, Sweden, during the period from 1951 to 1988 in whom pulmonary emboli were found at autopsy. The analysis included a comparison with the earlier analysed and reported time period from 1951 to 1980. A continued high frequency of pulmonary embolism at autopsy was seen during the 1980s (20·3 per cent of deaths, 31·7 per cent of autopsies). Of the 391 autopsy-verified pulmonary emboli found between 1981 and 1988, 113 (28·9 per cent) were considered fatal, 104 (26·6 per cent) contributed to death and 174 (44·5 per cent) were incidental. Few patients had symptomatic deep vein thrombosis or pulmonary embolism before death. The overall frequency of major pulmonary embolism in surgical patients remained unchanged (0·3 per cent). The frequency of major postoperative pulmonary embolism showed an increase during the 1950s and 1960s (maximum 0·4 per cent) but a decrease in the last 5-year period of the 1970s (0.3 per cent), which has earlier been reported upon. This decrease continued during the 1980s (0·2 per cent) (P&lt;0·05). An increase was found in the number of patients operated on who had autopsy-proven pulmonary embolism and who received thromboprophylaxis. Pulmonary embolism continues to be a major cause of death in surgical patients; however, postoperative major pulmonary embolism has shown a reduction in the last 15-year period.
Epidemiology of chronic venous ulcers
Authors: Baker S R , Stacey M C , Jopp-McKay A G , Hoskin S E , Thompson P J 
Published: March 2007

Abstract
A metropolitan population of 238000 in Perth, Western Australia, was screened for chronic ulceration of the leg. Patients with a chronic leg ulcer and a venous abnormality comprised 57 per cent of all patients with a chronic leg ulcer, giving a prevalence of 0·62 per 1000 population. There was an increasing prevalence with age; 90 per cent of patients were 60 years and older. This group comprised 16·7 per cent of the population, and had a prevalence of 3·3 per 1000. Although chronic venous ulcers were more common in women there was no difference in age related prevalence. In 36 per cent of patients with a venous abnormality, there was at least one other aetiological factor contributing to chronic ulceration of the leg; 96 per cent had either a history of deep venous thrombosis or a condition known to predispose to deep venous thrombosis.
Early computed colour echo Doppler imaging following renal transplantation
Authors: Rajaseker M R , Lodge J P A , Irving H C , Giles G R 
Published: March 2007

Abstract
Thirty patients with renal allografts were monitored for 15 postoperative days by colour-coded Doppler imaging and categorized as stable, rejection, acute tubular necrosis and cyclosporine toxicity. All forms of graft dysfunction showed significantly raised resistance (P&lt;0·01) and pulsatility (P&lt;0·01) indices (RI and PI, respectively). It was not possible to use Doppler imaging to differentiate the cause of graft dysfunction, but stable grafts in patients with high cyclosporine levels had significantly higher RI (P&lt;0·04) and PI (P&lt;0·04) than similar grafts in patients with cyclosporine levels in the therapeutic range.
Preoperative clinical evaluation as a predictor of cardiac complications after infrarenal aortic reconstruction
Authors: Chadwick L , Galland R B 
Published: March 2007

Abstract
This paper analyses cardiac risk factors in 93 consecutive patients undergoing elective infrarenal aortic reconstruction over a 2 year period. During the perioperative or postoperative period, 26 patients sustained a total of 42 cardiac complications. Eight patients had myocardial infarction, 14 left ventricular failure and 15 arrhythmias. There were five cardiac-related deaths. Angina was the only statistically significant risk factor in predicting postoperative cardiac problems. A multivariate analysis identified a high-risk group of patients in whom cardiac complications after operation were common.
Limitations of surgery in the treatment of retroperitoneal sarcoma
Authors: Alvarenga J-C , Ball A B S , Fisher C , Fryatt I , Jones L , Thomas J Meirion 
Published: March 2007

Abstract
A retrospective analysis was undertaken of 120 patients with retroperitoneal sarcoma referred to the Royal Marsden Hospital over a period of 20 years. The actuarial 5-year survival rate of all cases following referral was 29 per cent. On univariate and multivariate analysis the principal factors associated with an unfavourable prognosis were the presence of metastases, poor performance status at presentation, high tumour grade and incomplete excision of the primary tumour. The single most important factor affecting the ability to remove the primary tumour completely was multiple organ involvement. After apparently complete excision, however, the probability of local recurrence by 5 years was 85 per cent (95 per cent confidence interval 56–99). The prognosis of patients with retroperitoneal sarcoma is poor.
Healing of abdominal incisional hernia in infant rats
Authors: Tsui S , Ellis H 
Published: March 2007

Abstract
Incisional hernia following major laparotomy in adult humans occurs in 5 per cent of cases. Spontaneous healing of such hernias does not occur. We have devised a model for producing abdominal wall incisional hernia in the rat by dividing the linea alba subcutaneously through a small transverse skin incision. In adult rats (n = 17), an incisional hernia formed and progressively increased in size over 32 weeks. In 3-week-old infant rats (n = 17), all developed herniation immediately. In eight rats, these hernias progressively increased. In three, the hernias were healed at the third week, but recurred at the fourth, eighth and 12th weeks, respectively. In the remaining six animals, the hernias healed spontaneously at 3 weeks and remained healed. A similar observation of spontaneous healing of incisional hernias in children has been reported in one clinical paper. This animal model provides a useful means of studying the clinical difference between adult and infant with respect to incisional hernia.
Histopathological evaluation of oesophageal carcinoma: The significance of venous invasion
Authors: Theunissen P H M H , Borchard F , Poortvliet D C J 
Published: March 2007

Abstract
Follow-up data on 115 patients who had undergone surgical resection for oesophageal carcinoma were analysed. Histological sections were reviewed for tumour classification, grading and staging, and special stains were used to detect venous invasion. The effect of various factors on survival was statistically analysed using Cox's proportional hazards regression model. In this multivariate analysis lymph node metastasis was the most important variable in the assessment of survival (improvement ξ2 = 7·43, P = 0·006). Venous invasion, which was demonstrated with a frequency of 76·5 per cent (mostly intramural) was the second most important prognostic factor (improvement ξ2 = 2·86, P = 0·09). The relative risk for the presence of both variables was rather modest (3·09).