bluuebunny/crossref_metadata_2025_split huggingface dataset:
Future directions for conservative treatment of gallbladder calculi
Authors: O'Leary D P , Johnson A G 
Published: March 2007

Abstract
Recent conservative gallstone treatments provide rapid relief from symptoms, but all have a potential for stone recurrence. They are indicated in patients who are unfit or unwilling to undergo cholecystectomy. Wider application will depend on selection of patients who are at least risk of recurrence, or on development of effective prophylactic strategies.
Interleukin 2 therapy: current role in surgical oncological practice
Authors: Heys S D , Franks C R , Eremin O 
Published: March 2007

Abstract
The use of recombinant interleukin 2 (rIL-2) in clinical practice has opened up new and beneficial avenues in the treatment of certain malignant diseases. Although rIL-2 can stimulate a range of host antitumour defence mechanisms, only 30–40 per cent of patients who are treated will respond to such therapy as assessed by a reduction in tumour volume. The effect of rIL-2-based treatment schedules on delaying progression of disease and on overall survival in comparison with standard current treatments and chemotherapeutic regimens is not clear. Randomized clinical trials are required to evaluate precisely the role of rIL-2 in various therapeutic combinations and to ascertain the optimum therapeutic regimens for individual tumour types. Studies currently under way should provide more insight into the possible beneficial effects of immunotherapy with rIL-2. More basic research is required to ascertain how rIL-2 may produce its antitumour effects and why the therapeutic results obtained in humans have been so selective and less beneficial than those in experimental animals.
Quality-of-life measurement in surgical practice
Authors: Fraser S C A 
Published: March 2007

Abstract
Assessment of quality of life is gaining momentum in areas of medical practice where standard measures of outcome are not sensitive enough to determine treatment strategies. Such methods have not been widely adopted in the surgical specialties, although this is changing. The techniques used are easily understood but they have not been standardized and are subject to several confounding factors. Nevertheless, quality-of-life measurement may provide additional information in the research environment and surgical audit.
Early results and 1-year follow-up after intra-arterial thrombolysis
Authors: Browse D J , Torrie E P H , Galland R B 
Published: March 2007

Abstract
Intra-arterial thrombolysis (IAT) was used as first-line treatment for 100 occlusions causing acute, subacute or chronic ischaemia. Streptokinase was used in 90 cases and tissue plasminogen activator in the remaining ten. Complete lysis, as determined radiologically, was achieved in 55 per cent of cases and partial lysis in 20 per cent. Lysis was more effective the earlier it was used. Major complications occurred in seven cases: five patients suffered major haemorrhage, two of whom died, and two had haemorrhagic cerebrovascular accidents. Of the patients with complete or partial clearance of thrombosis, 19 had no underlying apparent cause, 23 underwent angioplasty and 15 had an operation. The 1-year patency rate following complete lysis was 58 per cent. The 1-year patency rate after successful treatment commencing within 1 week of symptoms starting was 71 per cent, compared with 36 per cent for later treatment. Aortofemoral bifurcation grafts were cleared in three of five cases and all remain patent. Eight popliteal aneurysms were demonstrated by IAT and were ligated and bypassed; all these grafts remained patent at follow-up. IAT is less effective in chronic than acute occlusion. It should be reserved for patients in whom the occlusion is of short duration or for those with a thrombosed aortofemoral bifurcation graft or popliteal aneurysm.
Effect of foot compression on the velocity and volume of blood flow in the deep veins
Authors: Andrews B , Sommerville K , Austin S , Wilson N , Browse N L 
Published: March 2007

Abstract
The A-V Impulse System reduces the incidence of deep vein thrombosis by pneumatically compressing the venae comitantes of the lateral plantar artery, causing an increase in the velocity of blood in the proximal axial veins. Using a duplex scanner the effects of altering the pressure, pulse duration and frequency of foot compression on the velocity and volume of blood flow in the superficial femoral and popliteal veins were quantified. In 20 legs, foot compression of 50, 125 and 200 mmHg significantly increased the maximum venous blood flow by 9·10, 13·4 and 15·1 ml/s respectively (P &lt; 0·001). Conversely, reducing the frequency of compression from 6 to 3 cycles per min significantly increased the rise in peak flow from 10·1 to 14·8 ml/s (P &lt;0·001). Changing the duration of compression from 1 to 3 s had no significannt effect on peak flow. Increased blood flow is best achieved with high-pressure low-frequency foot compression. Increasing the duration of compression beyond 1 s has no effect on augmentation of flow in the deep veins.
Helicopter Emergency Medical Service operating from the Royal London Hospital: the first year
Authors: Kirk C J C , Earlam R J , Wilson A W , Watkins E S 
Published: March 2007

Abstract
The additional workload on the support hospital created by using a helicopter for emergency trauma has been assessed in the first year of operation. A total of 135 patients were brought to the Royal London Hospital, of whom 30 died, 34 were transferred for convalescence or rehabilitation to another hospital, and 71 discharged home. The median Injury Severity Score was 17 (range 0–75) and 82 patients (60·7 per cent) had a reduced Revised Trauma Score at the scene. Blunt injury greatly outnumbered penetrating trauma (117 versus 15 patients). Accidental injuries accounted for 77·0 per cent of the total, self-inflicted wounds 14·1 per cent and assaults 8·9 per cent. Parameters employed to assess workload were hospital bed-days used (total 2361), operations (118, occupying 287 h of theatre time) and blood transfusion (total 702 units used). The second 6-month study period showed a considerable increase in the number of patients admitted (102 versus 33) because of increased efficiency in call-out procedures.
Crohn's disease and anastomotic recurrence: microvascular ischaemia and anastomotic healing in an animal model
Authors: Osborne M J , Hudson M , Piasecki C , Dhillon A P , Lewis A A M , Pounder R E , Wakefield A J 
Published: March 2007

Abstract
Microvascular injury and ischaemia may be factors in anastomotic recurrence after resection for Crohn's disease. This hypothesis was explored in a ferret model of multifocal intestinal infarction. At laparotomy, isolated loops of small intestine were injected intraarterially with styrene microspheres (test loop) or saline (control). At a second laparotomy 72 h later, test and control loops were divided and an end-to-end anastomosis performed between test loops (n = 2), test and control loops (n = 9) or control loops (n = 2). Abnormalities including chronic transmural inflammation, ulceration and granuloma formation were identified 2 weeks after the second operation in ten of the 11 surviving animals; changes were confined to the test loops and were most prominent adjacent to the anastomosis. No abnormalities were seen in control loops. The combination of two self-limiting ischaemic insults can produce a pattern of intestinal inflammation similar to that seen in anastomotic recurrence in Crohn's disease.
Comparative study of abdominal incision techniques
Authors: Telfer J R C , Canning G , Galloway D J 
Published: March 2007

Abstract
The characteristics of surgical incisions made with an electrosurgical technique were compared with those made using conventional methods in a prospective randomized trial. In particular, the claim that the method of incision may influence postoperative pain was investigated. A total of 101 consecutive patients receiving full-length midline laparotomy incisions for gastrointestinal resection were studied. A record was kept of the time required to make the incision and blood loss as well as postoperative pain (using a linear analogue scale), ventilatory function and requirement for analgesia. There were 50 patients in group 1 (scalpel; 15 men, 35 women) and 51 in group 2 (electrocautery; 26 men, 25 women). The groups were similar in age, body-weight, diagnosis and the type of surgical procedures being performed. Incision time was similar in the two groups but median blood loss during incision was significantly less in group 2 patients than in group 1 (10 versus 25 ml, P &lt; 0·0001). Linear analogue pain scores were not significantly different between the groups at any stage after operation. The same was true of postoperative ventilatory function and requirement for analgesia. A total value for morphine use during the entire postoperative period was derived for each group and the median was 1·55 mg/kg for group 1 compared with 1·49 mg/kg for group 2. The electrosurgical method is associated with less blood loss during incision, although this study has failed to confirm any reduction in postoperative pain or requirement for analgesia in these patients.
Porcine islet isolation: prospective comparison of automated and manual methods of pancreatic collagenase digestion
Authors: Toomey P , Chadwick D R , Contractor H , Bell P R F , James R F L , London N J M 
Published: March 2007

Abstract
A prospective study was undertaken to compare an automated method of porcine pancreatic digestion with a simpler manual procedure. These techniques have not previously been compared directly. After intraductal distension with collagenase, seven porcine pancreata were divided longitudinally; half of each was digested by the automated method and half by the manual technique. Islet yield and purity were measured. Compared with the manual technique, the automated method isolated a significantly greater total volume of islet tissue (median (range) 3·56 (1·39–5·30) versus 1·07 (0·46–1·92) mm3/g, P = 0·022), increased the median (range) number of 105-μm islet equivalents isolated (5875 (2294–8746) versus 1766 (759–3168) per g, P = 0·022) and improved the islet cleavage index (median (range) 92 (89–99) versus 82 (78–92) per cent, P = 0·035). It is concluded that, although the automated method is more complicated to set up, it greatly improves the yield of intact islets from the porcine pancreas.
Selective cholangiography in laparoscopic cholecystectomy
Authors: Grace P A , Qureshi A , Burke P , Leahy A , Brindley N , Osborne H , Lane B , Broe P , Bouchier-Hayes D 
Published: March 2007

Abstract
Laparoscopic cholecystectomy is now the method of choice for removing the diseased gallbladder. Asymptomatic common bile duct stones occur in approximately 6 per cent of patients. Controversy exists, however, as to whether selective or routine peroperative cholangiography should be performed during laparoscopic cholecystectomy. Over a 21-month period 300 consecutive laparoscopic cholecystectomies without routine cholangiography were attempted. There were 28 conversions. In all, 229 patients did not undergo cholangiography and in this group there were two common duct injuries. These were both identified and dealt with by open operation. Five patients underwent peroperative cholangiography, none of whom was found to have common duct pathology. Endoscopic retrograde cholangiopancreatography was performed in 38 patients. Of 27 who had this investigation performed before operation, common duct stones were diagnosed in seven (26 per cent). Two common duct stones were discovered in 11 patients who underwent the investigation after operation. Thus only two of 240 patients (0·8 per cent) who did not undergo preoperative or peroperative cholangiography subsequently had symptomatic duct stones. Peroperative cholangiography may be indicated in selected patients who have had symptoms of common bile duct stones or in those in whom the biliary anatomy is unclear. However, routine preoperative or peroperative cholangiography is unnecessary during laparoscopic cholecystectomy.
Screening practice for familial adenomatous polyposis: the potential for regional registers
Authors: Morton D G , Macdonald F , Haydon J , Cullen R , Barker G , Hultén M , Neoptolemos J P , Keighley M R B , McKeown C 
Published: March 2007

Abstract
Existing screening practice for familial adenomatous polyposis (FAP) was evaluated in 47 families with FAP notified to the West Midlands Polyposis Register between February 1988 and July 1990. Of these 269 individuals, 107 were known to be affected and 162 were at 50 per cent prior risk of developing FAP; 35 deceased affected individuals from living generations were included in the analysis. Of 105 individuals in the at-risk group aged between 12 and 40 years, only 55 (52 per cent) were under follow-up by bowel examination. Thirty-seven affected individuals had developed colorectal carcinoma before diagnosis; the incidence was three of 51 (6 per cent) in those diagnosed through screening compared with 34 of 53 (64 per cent) in the unscreened group (P &lt; 0·001). A total of 28 individuals (26 per cent of the FAP population) died from advanced colorectal carcinoma; all were from the unscreened population. In 22 (59 per cent) of the cases of colorectal carcinoma and 17 (61 per cent) of the deaths from advanced colorectal cancer there was a positive family history of FAP; these tumours were therefore potentially preventable through screening and prophylactic surgery. Since establishing the register the median age at diagnosis of the affected patients has been reduced from 32 to 23 years (P = 0·0004) and the incidence of colorectal cancer has fallen from 35 to 14 per cent (P &lt; 0·05). It is concluded that by providing more comprehensive case ascertainment a regional register can have a dramatic effect on this largely preventable form of colorectal cancer. Regional registers are recommended as an essential component of screening for this disease.
Cytokines, sepsis and immunomodulation
Authors: Molloy R G , Mannick J A , Rodrick M L 
Published: March 2007

Abstract
Tissue injury and infection produce significant alterations in host metabolic and immune homoeostasis. It is increasingly clear that many of these changes result from a complex cascade of mononuclear phagocyte-derived endogenous mediators. Among the more important is a group of host proteins called cytokines, which play an integral role in mediating the host response to tissue injury and infection. Of these proteins, tumour necrosis factor (TNF) and interleukin (IL) types 1 and 6 have received much attention for their pathophysiological roles in infection and trauma. Evidence is reviewed for the involvement of these cytokines in the characteristic alterations in the metabolic and immune responses to such injury. These endogenous mediators initiate an integrated fuel substrate and hormonal adjustment to trauma and sepsis, and help to provide optimal metabolic homoeostasis for systemic host defences. Widespread tissue injury, especially when associated with fulminant sepsis, may, however, precipitate massive release of TNF, IL-1 and IL-6, triggering a series of reactions involving multiple organs, and culminating in the “sepsis syndrome”. New therapies designed to downregulate this aberrant response, either by neutralizing endotoxin directly or by blocking the release or actions of these cytokines, are reviewed. Although these treatments hold much promise for the future management of severely traumatized and infected patients, careful evaluation of both the benefits and complications of therapy is needed before widespread clinical use can be recommended.
Splenectomy in human immunodeficiency virus-related thrombocytopenia
Authors: Alonso M , Gossot D , Bourstyn E , Galera M-J , Oksenhendler E , Celerier M , Clot Ph 
Published: March 2007

Abstract
To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count &lt;50 × 109/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.
Percutaneous ultrasound-guided drainage of intra-abdominal abscesses
Authors: Goletti O , Lippolis P V , Chiarugi M , Ghiselli G , De Negri2 F , Conte M , Ceragioli T , Cavina E 
Published: March 2007

Abstract
A retrospective review of 200 patients with intra-abdominal abscesses treated by percutaneous ultrasound-guided drainage is reported. Abscesses were simple in 151 patients (75.5 per cent) and complex in 49 (24.5 per cent). In 12 patients the abscess communicated with the gastrointestinal tract. There were 17 critically ill patients for whom percutaneous drainage was the only therapeutic option possible. The success rate was 94.7 per cent (143 of 151 patients) for simple abscess and 69 per cent (34 of 49) for complex abscess. The overall success rate was 88.5 per cent. The mortality rate was 1.3 per cent (two patients) for simple and 16 per cent (eight patients) for complex abscess. The overall mortality rate was 5.0 per cent. Percutaneous ultrasound-guided drainage should be the initial drainage procedure in patients with a simple abdominal abscess. The presence of a complex abscess should not prevent an attempt at percutaneous catheter drainage, particularly in high-risk patients, although the risk of failure is greater in such cases.
Fully implantable venous access systems
Authors: Ramirez J M , Miguelena J M , Güemes A , Moncada E , Cabezali R , Sousa R 
Published: March 2007

Abstract
Central access systems are a considerable step forward in the treatment of patients with cancer. Experience with totally implantable vascular access systems is reported. Since 1986, 185 reservoir pumps have been implanted. Access was by percutaneous cannulation of the subclavian vein in 130 cases (70 per cent) and surgical exposure of the external jugular vein in 40 (22 per cent); other sites of insertion were used in 15 cases (8 per cent). The mean duration of use of the reservoirs was 276 (range 1–632) days (total 51 150 catheter-days). The mean number of injections was 390 (range 2–670). The total number of complications, mostly mechanical, was 25 (0.5 per 1000 catheter-days). Fully implantable venous access systems are safe and reliable, and their complications can be prevented with adequate management.
Oesophagectomy by a transhiatal approach or thoracotomy: A prospective randomized trial
Authors: Goldminc M , Maddern G , Le Prise E , Meunier B , Campion J P , Launois B 
Published: March 2007

AbstractA prospective randomized trial of 67 patients undergoing oesophagectomy by either a transhiatal approach or right-sided thoracotomy was conducted over a 40-month period. In 32 patients the approach was transhiatal and 35 had a thoracotomy; the groups were well matched before operation. There were two hospital deaths in patients having the transhiatal oesophagectomy and three in those undergoing thoracotomy. Blood transfusion, intensive care stay and overall time of hospitalization were not significantly different between the two groups. There was no difference in the postoperative morbidity rate and, in particular, the incidences of pulmonary complications were similar (19 per cent for transhiatal oesophagectomy, 20 per cent for thoracotomy) with anastomotic fistula in 6 and 9 per cent respectively. The median (range) operating time was significantly longer in patients having thoracotomy (6 (3.5–9.5) versus 4 (3–8) h). Long-term survival was unaffected by the type of operation performed or addition of preoperative chemotherapy or radiotherapy. Nodal status was a signficant prognostic factor within but not between the two groups. It is concluded that oesophagectomy by a transhiatal route or right thoracotomy are equally effective surgical options for treatment of squamous cell oesophageal cancer.
Resection of presumed benign liver tumours
Authors: Belghiti J , Pateron D , Panis Y , Vilgrain V , Fléjou J-F , Benhamou J-P , Fékété F 
Published: March 2007

Abstract
The surgical treatment of benign liver tumours (focal nodular hyperplasia (FNH) and hepatic adenoma) remains controversial. From 1984 to 1990, all 51 women aged below 50 years who presented with presumed benign liver tumours and without chronic liver disease underwent tumour resection. Preoperative assessment included liver tests, ultrasonography and dynamic computed tomography in all patients, plus angiography (n = 20), magnetic resonance imaging (n = 22) and technetium–sulphur colloid liver scintigraphy (n = 19). The aims of this study were to compare preoperative and final pathological diagnosis and determine whether surgical treatment was justified. Preoperative assessment suggested FNH in 18 patients and hepatic adenoma in 11. In 22 patients, the distinction between FNH and adenoma could not be determined before operation. Operative procedures included resection of one segment or less in 22 patients, two segments in 14 and three or more segments in 15. There was no postoperative death and no serious complication. The final diagnosis after pathological examination of resected specimens was FNH in 36 patients (71 per cent), including the 18 presumed before operation to have FNH, hepatic adenoma in 12 (24 per cent) and malignant lesions in three (6 per cent): hepatocellular carcinoma (HCC) arising in normal liver, fibrolamellar carcinoma, and adenoma containing areas of HCC in one patient each. In conclusion: (1) precise preoperative diagnosis of benign liver tumours remains difficult despite new imaging methods; (2) malignant liver tumours can go unrecognized; and (3) resection of all these lesions can be carried out safely. Resection of presumed benign liver tumours should be performed in young women when a preoperative diagnosis of FNH is not firmly established.
Clinical trial of tamoxifen in patients with irresectable pancreatic adenocarcinoma
Authors: Taylor O M , Benson E A , McMahon M J 
Published: March 2007

Abstract
Oestrogen-binding sites are present in tissue samples of adenocarcinoma of the pancreas. Uncontrolled studies have suggested that survival of patients with this tumour may be extended by using the antioestrogen drug tamoxifen. Forty-four patients with biopsy-proven irresectable adenocarcinoma of the pancreas were recruited into a randomized placebo-controlled clinical trial of tamoxifen 20 mg twice daily. All patients were assessed at the time of diagnosis and at monthly intervals using the Karnofsky and the Hospital Anxiety and Depression scores for quality of life. Analysis of survival by life-tables and the log rank test revealed no significant difference in the duration of survival of patients treated with tamoxifen or placebo. Quality-of-life assessment revealed no significant difference between the groups. Tamoxifen does not confer significant benefit to patients with irresectable pancreatic cancer.
Suppression of macrophage function by suture materials and anastomotic recurrence of Crohn's disease
Authors: Scott A D N , Uff C , Phillips R K S 
Published: March 2007

Abstract
After surgical excision of bowel, Crohn's disease is likely to recur around the anastomosis. It is suggested that this may indicate a biological effect of suture materials on gastrointestinal immunology. To investigate this, the influence of six suture materials on the functiono f macrophages the influence of six suture materials on the function of macrophages obtained from the rat peritoneal cavity and human intestinal mucosa was assessed. All materials significnatly impaired macrophage function.