bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early cardiorespiratory findings after severe blunt thoracic trauma and their relation to outcome
Authors: Rady M Y , Edwards J D , Nightingale P 
Published: March 2007

Abstract
This study examined the initial haemodynamic and oxygen transport patterns in 24 patients with severe blunt thoracic trauma in whom immediate monitoring with femoral and pulmonary artery catheters was required after admission to the intensive care unit. All patients required mechanical ventilation and were studied before receiving inhalational anaesthesia and within 12 h of injury. Two groups of patients were identified; nine patients (group 1) had an impaired left ventricular stroke work index (LVSWI) and 15 patients had a normal LVSWI (group 2). There were no significant diferences in the abbreviated injury scale score for the chest, the total injury severity score, or the mean ages of the two groups. There were significant diferences in stroke volume index, 32 versus 56 ml m −2 (P &lt; 0.001), and cardiac index, 3.2 versus 5.3 l min−1 min−2 (P &lt; 0.001), and therefore in oxygen delivery, 469 versus 852 ml min−1 m−2 (P &lt; 0.001), despite apparently adequate volume expansion using the same protocol and clinical criteria in both groups. Oxygen consumption was not significantly diferent in the two groups, 135 versus 157ml min−1 m−2, because of a higher oxygen extraction ratio in group 1, 29 versus 19 per cent (P &lt; 0.001), and hence lower mixed venous oxygen saturation, 73 versus 82 per cent (P &lt; 0.02). Seven patients in group 1 died (78 per cent) compared with two in group 2 (13 per cent). Early depression of cardiac, function is associated with poor outcome in patients with thoracic trauma, and measurements of oxygen transport variables may influence resuscitation and the timing of surgical procedures.
Effect of transforming growth factor beta and basic fibroblast growth factor on steroid-impaired healing intestinal wounds
Authors: Slavin J , Nash J R , Kingsnorth A N 
Published: March 2007

Abstract
A longitudinal intestinal wound model in the pig was used to assess the effect of parenteral steroids (betamethasone 12 mg 50 kg−1 intramuscularly twice daily) on breaking load. Steroid treatment significantly decreased the breaking load of wounds in the ileum and colon in comparison with wounds from saline-treated animals. In a further group of animals receiving steroids, paired longitudinal wounds were constructed. One wound of a pair was treated with a local application of transforming growth factor beta (TGF-β) (5 μg per wound) or basic fibroblast growth factor (5 μg per wound) in a collagen suspension. The other wound was treated with a collagen suspension alone. Ileal wounds treated with TGF-β were significantly stronger than collagen-treated controls at 7 days. The steroid-induced impairment of breaking load in intestinal wounds is partially reversed by a local application of TGF-β in a collagen suspension at the time of surgery.
Early reoperation after major vascular surgery: a four-year prospective analysis
Authors: Davies A H , Pope I , Collin J , Morris P J 
Published: March 2007

Abstract
Between I January 1985 and 31 December 1988, 1176 major vascular operations were performed on 1040 patients by the Oxford Regional Vascular Service, of which 136 (12 per cent) were reoperations within 30 days of the initial procedure (110 patients). Sixty-seven (49 per cent) of the reoperations were attempted revascularizations, 43 (32 per cent) were amputations, and surgery for bleeding accounted for 18 (13 per cent). Of the first reoperations 71 (65 per cent) were successful, but among the remaining 39 patients, 17 underwent 26 further reoperations, 15 of which were reoperations for revascularization. The 30-day mortality rate for patients undergoing one reoperation was 13 per cent; this rose to 35 per cent if more than one reoperation was performed. Early reoperation after major vascular surgery is common and carries a high operative mortality. This should be borne in mind when obtaining the informed consent of the patient.
Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up
Authors: Mitchell D C , Murray A , Wood R F M , Grasty M , Smith R E , Dacie J E , Walters T K , Cotton G 
Published: March 2007

Abstract
A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilafarion. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss. The median occlusion length was 18 (range 0.5–58) cm. Technical success was achieved in 58 limbs (74 per cent) with clinicalsuccess in 46 (59 per cent). Success rates fell with increasing length of occlusion. Two patients died in the perioperative period. A subgroup of 22 patients with marked discrete arterial calcificarion had a lower technical success rate than the subgroup without calcification (50 per cent versus 84 per cent, P &lt; 0·01). Both subgroups displayed a similar pattern of reclosure during follow-up. The cumulative patency rate after technical success was 67 per cent at 6 months and 45 per cent at 12 months. Forty-six (59 per cent) limbs avoided bypass surgery or amputation. Laser-assisted angioplasty may offer an alternative to femoropapliteal bypass, although the former procedure is not as durable.
Acute colonic pseudo-obstruction
Authors: Dorudi S , Berry A R , Kettlewell M G W 
Published: March 2007

Abstract
The syndrome of acute colonic pseudo-obstruction is well delineated but its aetiology remains poorly understood and patients are still treated inappropriately. This article reviews the pathogenesis and surgical management of this condition. Early diagnosis is stressed as a pivotal factor in reducing morbidity and mortality.
Abdominal rectopexy for rectal prolapse: a comparison of techniques
Authors: Duthie G S , Bartolo D C C 
Published: March 2007

Abstract
To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence inpatients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18–83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex® rectopexy (n = 20), posterior Ivalon® rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper anal sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.
Prognostic factors from computed tomography in acute left colonic diverticulitis
Authors: Ambrosetti P , Robert J , Witzig J A , Mirescu D , de Gautard R , Borst F , Meyer P , Rohner A 
Published: March 2007

Abstract
This prospective study examined factors which may predict a poor outcome (complications and recurrence) after a first attack of diverticulitis which has been successfully managed conservatively. Twenty-four of 107 patients who entered the study had a poor outcome: persistent diverticulitis (nine cases), recurrence (seven cases), colonic stenosis (six cases), residual parasigmoid abscess (one case) and colovesical fistula (one case). Eight of the 18 men aged 50 years or less had a poor outcome compared with 16 of the remaining 89 patients (P = 0.032). Twelve of 76 patients (16 per cent) with mild findings on computed tomography (CT) (localized thickening of colonic wall and inflammation of pericolic fat) had a poor outcome compared with 11 of 23 patients (48 per cent) whose CT was estimated as severe (abscess and/or extraluminal air and/or extraluminal Gastrografin®) (P = 0.004). These results suggest that elective colectomy can be proposed after afirst attack of acute left diverticulitis in men up to 50 years of age and/or in patients whose initial CT reveals findings of severe diverticulitis.
In vitro modulation of haematoporphyrin derivative photodynamic therapy on colorectal carcinoma multicellular spheroids by verapamil
Authors: Purkiss S F , Grahn M F , Turkish M , Macey M G , Williams N S 
Published: March 2007

Abstract
Photodynamic therapy has possible applications in the treatment of colorectal carcinoma. The photosensitizer haematoporphyrin derivative (HpD) is selectively retained by tumours. Agents which block p-glycoprotein, an export protein expressed to increased levels in a high proportion of colorectal carcinomas, may modulate photodynamic therapy by reducing HpD efflux from cells. Multicellular spheroids derived from the colorectal cell lines HRT18 and HT29 were incubated for 24 h with 1 μg ml−1 HpD and 0, 1, 2 and 4 μM verapamil. Bioactivity demonstrated a dose-dependent potentiation of HpD-photodynamic therapy growth retardation. Clonogenic survival of cells disaggregated from spheroids treated with HpD-photodynamic therapy was reduced when spheroids were coincubated with verapamil. The mean(s.e.m.) efflux of HpD from spheroids into fresh medium assessed by fluorimetry was greater in spheroids treated with HpD alone (93.2(18.8) arbitrary units ml−1) than in those treated with verapamil (18.1(2.8) arbitrary units ml−1), P = 0.003. Flow cytometry demonstrated increased HpD fluorescence in cells derived from spheroids coincubated with verapamil over a range of HpD incubation concentrations. Verapamil can potentiate the bioactivity of HpD-photodynamic therapy and HpD may be a substrate for p-glycoprotein.
Ileoanal pouch compliance and motor function
Authors: Levitt M D , Kamm M A , Groom J , Hawley P R , Nicholls R J 
Published: March 2007

Abstract
Measurement of intrapouch pressure during continuous distension with water (pouchmetrography) was performed in ten patients with good pouch function after restorative proctocolectomy and a ‘normal’ baseline pressure curve was constructed from the mean pressures at 50-ml intervals. Eight other patients with poor pouch function were studied and the two groups were compared. Patients with poor function had significantly lower maximum tolerated volumes (297.5 versus 565 ml, P &lt; 0.02) and volumes which caused urgency (135 versus 265 ml, P &lt; 0.02). Baseline pressure curves were above the upper limit of the normal range (mean plus two standard deviations) for a substantial proportion of the recording in six of the patients with poor function. Large, isolated contraction waves were recorded in six of ten patients with good function and in three of those with poor function. Rhythmic waves were frequently seen in both groups but were more prominent in patients with poor function. Pouchmetrography is a provocative test of pouch motor function which may unmask abnormal muscle activity resulting from reduced compliance or a primary motility disorder.
Influence of dietary calcium supplements on ileoanal pouch function and cytokinetics
Authors: Barsoum G H , Winslet M , Youngs D , Neoptolemos J P , Keighley M R B 
Published: March 2007

Abstract
A double-blind cross-over study was undertaken in 16 patients after panproctocolectomy and ileoanal pouch reconstruction to compare supplementary calcium (1.5 g/day) with placebo over 2 months with a 2-week washout period. Stool frequency was recorded and the eflects on pouch mucosal crypt cellular proliferation were determined using an in vitro stathmokinetic technique which measures the crypt cell production rate (CCPR) and an immunohistochemical method using the Ki67 monoclonal antibody for proliferating nuclei. The median (interquartile range) diurnal stool frequency was reduced by calcium (4 (3–5) per day) compared with values obtained before treatment (7 (5–10) per day, P &lt; 0.002) and with placebo (7 (6–9) per day, P = 0.002). Similarly, calcium reduced nocturnal stool frequency (1 (0–1)per night) compared with pretreatment and placebo (both 2 (1–3) per night, P &lt; 0.05) values. Calcium reduced the mean(s.e.m.) CCPR to 1.88(0.41) cells per crypt per hour compared with pretreatment (3.63(0.53), P = 0.01) and placebo (3.24(0.43), P = 0.002) values. Median (interquartile range) Ki67 activity was also reduced by calcium (13.2 (9.7–16.7) per cent), compared with values obtained before treatment (27.3 (14.3–30.2) per cent, P = 0.001) and with placebo (26.0 (17.2–32.0) per cent, P = 0.001). Stool frequency was significantly correlated with the CCPR (diurnal: r = 0.37; nocturnal: r = 0.31, both P &lt; 0.05). Nine patients used antidiarrhoeal medication while receiving placebo compared with four patients receiving calcium (P = 0.032). This study has shown that supplementary oral calcium significantly reduced stool frequency in patients with pouches, a reduction that was associated with reduced cell proliferation. The mechanisms for this eflect are not known.
Congenital duodenal obstruction
Authors: Akhtar J , Guiney E J 
Published: March 2007

Abstract
Over the period 1980–1989, 49 patients with congenital duodenal obstruction due to duodenal atresia, duodenal stenosis or annular pancreas were treated. There were three deaths, all related to associated severe congenital anomalies and none related to surgery for duodenal obstruction; 78 per cent of the patients had associated congenital anomalies which, in some instances, complicated their management. Prenatal diagnosis by ultrasonography was made in 18 per cent of the patients and these patients had operations relatively earlier.
Accurate method to measure the percentage hepatic replacement by tumour and its use in prognosis of patients with advanced colorectal cancer
Authors: Purkiss S F , Williams N S 
Published: March 2007

Abstract
The natural history of patients with colorectal hepatic metastases was studied following resection of the primary tumour. Patients were stratified according to the presence of extrahepatic disease and the percentage hepatic replacement (PHR) measured by planimetry of computed tomographic images. The median(semi-interquartile range (s.i.r.)) PHR of patients without extrahepatic disease was 15.0(10.5) and for those with extrahepatic disease 5.4(2.2) (P &lt; 0.02). The median(s.i.r) PHR of all patients was 8.7(8.5). The median(s.i.r.) survival of all patients was 125(85.5) days, 92(114) days for patients with extrahepatic disease and 175(133.5) days for patients with disease confined to the liver (P &lt; 0.02). A linear correlation between the natural logarithm of PHR and survival was demonstrated (ρ = −0.76, P &lt; 0.001) for patients without extrahepatic disease. Extrahepatic disease in patients with colorectal hepatic metastases is a major determinant of survival; PHR has a direct association when extrahepatic disease is absent.
Repeated hepatic resection for recurrent metastases from colorectal cancer
Authors: Bozzetti F , Bignami P , Montalto F , Doci R , Gennari L 
Published: March 2007

Abstract
Since 1980 120 patients with hepatic metastases from colorectal cancer underwent surgery at the Istituto Nazionale Tumori of Milan. Of these, 34 developed recurrence in the liver only and 11 underwent repeat surgery. The median interval between the two resections was 10 months and operative morbidity and mortality rates were 40 per cent and 9 per cent respectively. Nine patients with adequate follow-up were evaluated and after a median follow-up of 17 months four were alive and disease-free, two were alive with lung metastases and hepatic relapse and three had died. The overall median survival of these patients was 23 months.
Flushing technique in the management of retained common bile duct stones with a T tube in situ
Authors: Soravia C , Meyer P , Mentha G , Ambrosetti P , Rohner A 
Published: March 2007

Abstract
Over a 12-year-period, 6046 cholecystectomies and 918 common bile duct explorations were undertaken with 697 stone-positive choledochotomies (76 per cent). Forty patients (5.7 per cent) had retained common bile duct stones with a T tube in situ. Twenty-eight patients underwent flushing of the common bile duct with a continuous infusion of heparinized saline solution with parenteral aminophylline to induce relaxation of the sphincter of Oddi. Complete duct clearance was achieved in 17 patients; infusion was stopped in four patients and no deaths occurred. The use of percutaneous stone extraction (Burhenne's technique), gave an overall successful common bile duct clearance rate of 86 per cent. The flushing technique represents the first step in the non-operative management of retained common bile duct stones in patients with a T tube in place. It is a safe and efective method for use in the early postoperative period with a prolongation of hospital stay of not more than 1 week.
Pylorus-preserving versus standard pancreaticoduodenectomy: an analysis of 110 pancreatic and periampullary carcinomas
Authors: Roder J D , Stein H J , Hüttl W , Siewert J R 
Published: March 2007

Abstract
Pylorus-preserving pancreaticoduodenectomy (PPPD) has received increasing attention as a physiological alternative to the standurd pancreaticoduodenectomy (PD) in patients with adenocarcinoma of the pancreatic head or the periampullary region. We evaluated mortality, morbidity and survival in 110 patients with pancreatic carcinoma (n = 53) or periampullary carcinoma (n = 57). In each group 31 patients underwent PD, the remainder PPPD. There were no differences in age, sex and tumour stage (UICC 1987) between patients undergoing PPPD or PD. Median follow-up was 24 months. There were no significant differences in mortality and morbidity rates between procedures. The mode of resection had no influence on survival in patients with periampullary carcinoma. Patients with pancreatic carcinoma who underwent PD had a significantly better survival rate compared with those who underwent PPPD (P ≤ 0.05). This was particularly so in patients with stage III tumours (P = 0.007). These data suggest that in patients with ductal carcinoma of the head of the pancreas, PD provides better survival than PPPD. However, PPPD appears to achieve equivalent results to PD in patients with periampullary carcinoma.
Oesophagitis and pH of refluxate: an experimental and clinical study
Authors: Zaninotto G , di Mario F , Costantini M , Baffa R , Germanà B , Dal Santo P L , Rugge M , Bolzan M , Naccarato R , Ancona E 
Published: March 2007

Abstract
This experimental and clinical study examined the relationship between oesophageal damage and optimal pH of refuxate, and whether 24-h pH monitoring at optimal pH could discriminate the severity of oesophagitis. The rabbit oesophagus was perfused in vivo with pepsin and hydrochloric acid solutions of difering pH for 60 min. Maximal oesophageal damage coincided with peptic solutions at pH 1.5–2.5. Fifty-nine patients with proven gastro-oesophageal reflux disorders were tested for manometric features of the lower oesophageal sphincter (Pressure, overall length and abdominal length) and oesophageal exposure to different pH levels. They were classified into four groups according to the endoscopically demonstrated severity of oesophagitis. Supine exposure at the optimal pH level for pepsin activity (pH 1.5–2.5) and overall sphincter length were found to discriminate the severity of oesophagitis reliably in 75 per cent of cases.
Delays in care of the critically injured
Authors: McNicholl B P , Dearden C H 
Published: March 2007

Abstract
Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identify factors causing delay in emergency care. Eighteen patients required emergency surgery in the first group and 13 in the second. The mean presurgery time (i.e. time from arrival in the accident and emergency department to surgery) was 117 min in the first group and 111 min in the second. Causes of delay included a sequential approach to resuscitation and investigation, limited staff and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.
Long-term changes in muscle free amino acid levels after elective abdominal surgery
Authors: Peterson B , Vinnars E , Waller S-O , Wernerman J 
Published: March 2007

Abstract
Characteristic changes in the pattern of muscle free amino acids are seen on the third day after elective surgery. The time course of the restoration to normal levels in uncomplicated cases has not been established before. Seven metabolically healthy patients undergoing cholecystectomy were studied. Muscle biopsy specimens and plasma samples were taken before operation and on days 3,10,20 and 30 after surgery. The level of total free amino acids in skeletal muscle decreased and the concentrations of branched chain and aromatic amino acids increased on day 3. The original levels were found to be restored on day 10 after surgery. A decrease in glutamine of 38per cent (P &lt; 0·001) was seen on day 3, of 20 per cent (P &lt; 0·05) on day 10 and of 22 per cent (P &lt; 0·05) on day 30, compared with preoperative values. These results constitute a baseline for future studies in which the impact of nutritional and pharmacological therapies is to be evaluated beyond the immediate postoperative period.
Dormant liver metastases: an experimental study
Authors: Panis Y , Ribeiro J , Chrétien Y , Nordlinger B 
Published: March 2007

Abstract
Experimental work was undertaken to evaluate whether intrahepatic recurrences, observed after resection of colorectal liver metastases in humans, could be due to the activation of dormant cancer cells already present within the liver at liver resection. About 250 cell aggregates (DHDK12 colon carcinoma cell line) were injected into the portal vein of 70 BD IX rats. Eight weeks later, 43 rats with no apparent liver metastases were divided randomly into three groups: group 1(n = 15) served as control; group 2(n = 15) were given cyclosporin A(10 mg kg body-weight−1 day−1) for 28 days; and group 3 (n = 13) underwent a 70 per cent hepatectomy. Twelve weeks after the injection of cells, when the animals were killed, 20 per cent of rats in group 1 had liver metastases, 80 per cent in group 2 (P &lt; 0·01) and 62 per cent in group 3(P &lt; 0·05). Undetectable liver micrometastases may have been present at 8 weeks and had not developed until stimulation by cyclosporin A-induced immunosuppression or by liver regeneration after hepatectomy. A similar mechanism may occur clinically and explain some of the recurrences observed after resection of liver metastases.
Partial hepatic resection under intermittent hepatic inflow occlusion in patients with chronic liver disease
Authors: Ezaki T , Seo Y , Tomoda H , Furusawa M , Kanematsu T , Sugimachi K 
Published: March 2007

Abstract
A partial hepatic resection was performed in 13 patients with chronic liver disease using intermittent hepatic inflow occlusion. Eleven patients had liver cirrhosis and two had chronic hepatitis. Seven patients were classified as Child's grade A and six as Child's grade B before operation. Dissection of the hepatic parenchyma was performed during intermittent inflow occlusion. The time of clamping and declamping was 10–20 min and 5–8 min, respectively. Postoperative data on liver function showed recovery to preoperative levels by about 10 days after operation. There were no life-threatening complications. These results indicate that intermittent hepatic inflow occlusion can be achieved easily and safely to allow non-anatomical resection in patients with chronic liver disease.