bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leucine kinetics in surgical patients I: A study of the effect of surgical ‘stress’
Authors: Harrison R A , Lewin M R , Halliday D , Clark C G 
Published: March 2007

Abstract
At present there is no consensus about the effect of surgical and accidental trauma on protein metabolism. Leucine kinetics, an index of protein turnover, have been studied in ten patients before intra-abdominal surgery and on either the third (n = 5) or seventh (n = 5) postoperative day. Only small changes in leucine kinetics were noted in the early postoperative study but, by the seventh day, there was evidence of increased synthesis as part of an overall elevation of turnover rates. It is suggested that the previously expressed opinion that protein synthesis is reduced after surgery must be re-examined.
Leucine kinetics in surgical patients II: A study of the effect of malignant disease and tumour burden
Authors: Harrison R A , Lewin M R , Halliday D , Clark C G 
Published: March 2007

Abstract
Isotope studies of protein turnover have given conflicting evidence about the effects of a malignant tumour on the protein metabolism of the host. Leucine kinetics have been studied, as an index of protein turnover, using a well established methodology. Twenty patients were studied, five with benign disease of the colon, ten with localized malignant tumours of the large bowel, and five in whom there was evidence of metastatic disease from a colonic primary. No effect was observed on the leucine turnover of the patients that might be attributable to the presence or size of the tumour burden. It is suggested that some of the previously conflicting results may be attributable to variability in the experimental design, the heterogeneous patient groups studied and the methods used to express the results obtained.
Salvage surgery for advanced local recurrence of breast cancer
Authors: Flook D , Webster D J T , Hughes L E , Mansel R W 
Published: March 2007

Abstract
The development of myocutaneous flaps and other reconstructive procedures has made it possible to offer surgical palliation to many patients with advanced local recurrence of breast cancer who previously would have been regarded as untreatable. We present the results of excision of such recurrences in 42 patients treated from 1982 to 1986 after non-surgical measures had failed. Good palliation was achieved in all of the patients with acceptable morbidity. There was one death. Further local recurrences developed in 12 (29percent) patients, though none was painful or offensive. Thirteen patients remain alive and free from local disease; 17 patients remained free from local disease until they died.
Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review
Authors: Stonebridge P A , Ciason A E , Duncan A J , Nolan B , Jenkins A Mcl , Ruckley C V 
Published: March 2007

Abstract
A series of 61 patients with acute upper limb ischaemia treated over a 5-year period is analysed and compared with patients presenting with acute lower limb ischaemia during the same period. The mean age was 74 years with a female to male ratio of 2.2:1. Eighty-two per cent were treated by operation. Three patients died and no survivors required a major or minor limb amputation, in contrast to a 5 per cent major limb amputation rate in patients with acute lower limb ischaemia. Mortality for upper limb ischaemia was 5 per cent compared with a 30 per cent mortality rate in patients with acute lower limb ischaemia in whom cardiopulmonary debility (New York Heart Association score 3–4) was significantly greater.
Extended role for needle biopsy in the management of carcinoma of the breast
Authors: Baildam A D , Turnbull L , Howell A , Barnes D M , Sellwood R A 
Published: March 2007

Abstract
Treatment choice in primary breast cancer is wide and still controversial; it seems likely that the optimum treatment for individual patients could be dictated by biological indicators of tumour behaviour. If biopsy could provide prognostic information as well as detailed tissue diagnosis then definitive treatment, with or without adjuvant systemic therapy, could be planned from the outset. We studied 140 patients with a clinical diagnosis of primary breast cancer to determine how much information could be obtained from Tru-Cut® needle biopsies performed at the first clinic visit. Ten patients were found to have benign disease. Of 130 carcinomas, 123 (95 per cent sensitivity) were diagnosed correctly from the needle biopsies, with seven false negative and no false positive results (100 per cent specificity). Precise histopathology was predicted in 121 (93 per cent). Grade was correctly assessed in 77 of 112 (69 per cent), but needle biopsy was not accurate for assessment of lymphatic invasion nor elastosis. Steroid hormone receptors were assayed in 59 needle biopsies, and the incidence of oestrogen receptor positivity (34, 58 per cent) was similar to the resected tumours (35, 59 per cent), but the incidence of progesterone receptor positivity (26, 44 per cent) was lower (33, 56 per cent, P &lt; 0·04). Immunostaining with monoclonal antibody human milk fat globule membrane was accurate in the needle biopsies. DNA analysis by flow cytometry was performed in 37 tumours and the concordance between needle biopsies and resected samples was high. Tru-Cut needle biopsy obviates open biopsy and gives reliable detailed information.
Omental transposition in the treatment of locally advanced and recurrent breast cancer
Authors: Williams R J L , Fryatt I J C , Abbott W C , White H 
Published: March 2007

Abstract
An analysis was carried out of 43 patients treated by omental transposition for locoregional problems associated with breast cancer. Indications for surgery included advanced primary tumour (five), locally recurrent tumour (32), radiation induced sarcoma (two), and radionecrosis (four). Tumours were typically extensive (mean diameter 7·2 cm) and skin ulceration affected 30 patients. Other treatment modalities had been exhausted. Surgical excision followed by reconstruction using transposed omentum resulted in worthwhile local control and symptom relief in 31 patients (median duration 22 months). Chest wall disease rapidly recurred peripheral to the omental graft in 12 patients. On multiple regression analysis, duration of local control was significantly related to tumour diameter, ulceration, and earlier radioresistance (hazard ratios 15·8, 3·8 and 14·8 respectively). Survival (median 21, range from 1·5 to 122 months) correlated with tumour size, previous chemotherapy, and early re-recurrence (hazard ratios 7·2, 3·0 and 4·3). Omental transfer is a reliable method of restoring epithelial cover after radical surgery and is particularly useful after previous irradiation injury. In advanced and recurrent breast cancer, an aggressive surgical approach significantly improved the quality of life of most patients, but careful case selection is required to avoid inappropriate surgery for irremediable tumours.
Graft occlusion following aortofemoral bypass for peripheral ischaemia
Authors: Naylor A R , Ah-See A K , Engeset J 
Published: March 2007

Abstract
Over a 10-year period, 241 patients with non-aneurysmal aortoiliac disease underwent aortofemoral bypass to 476 limbs. Four patients (1·7 per cent) occluded their grafts within 30 days of surgery, while 25 (10·4 per cent) suffered late graft occlusion. Postoperative occlusions were associated with significant morbidity and only one patient avoided major limb amputation or death. Overall, 46 episodes of graft thrombosis involving 51 graft limbs were encountered, the most common underlying cause being pre-existing or progressive multilevel distal occlusive disease. The overall cumulative graft patency rates were 95 and 87 per cent at 1 and 5 years respectively. Cumulative 5-year patency was significantly higher in patients presenting with claudication (91 per cent) than in patients presenting with rest pain (77 per cent) or ulceration and/or gangrene (71 per cent). Patients with evidence of multilevel distal occlusive disease at the time of aortic surgery had a significantly higher incidence of occlusion compared with those in whom there was no significant distal disease. In 35 episodes of occlusion (76 per cent), surgery was undertaken to restore limb blood flow, being successful in all but one case, with the most commonly performed procedure being graft limb thrombectomy. Seven of 28 patients (25 per cent) ultimately required major limb amputation and three patients died as a direct consequence of graft thrombosis.
Role of venous elasticity in the development of varicose veins
Authors: Clarke H , Smith S R G , Vasdekis S N , Hobbs J T , Nicolaides A N 
Published: March 2007

Abstract
A reduction in the ‘elasticity’ of the venous system has been proposed as a precursor of venous insufficiency, but the concept remains controversial. This study was designed to develop a method of assessing venous elasticity, and to use this method to investigate the aetiology of varicose veins. Simultaneous measurements of calf volume (determined using strain gauge plethysmography) and venous pressure (obtained via a dorsal foot vein) were made during venous occlusion plethysmography. The elastic modulus, K, defined as stress/strain when the veins are full, was calculated from the pressure/volume relationship. The elastic modulus was determined in 19 normal legs, 33 legs with superficial venous insufficiency, 16 legs with deep venous insufficiency, and 18 legs of a high risk group of volunteers or patients without varicose veins but with a strong history of factors associated with their development. The results showed a clear difference in elasticity between normal limbs and limbs with varicose veins, and also between normal limbs and high risk limbs. These results support the hypothesis that reduced elasticity has a role in the development of varicose veins and precedes the onset of valvular incompetence.
Lower limb vein trauma: A long-term clinical and physiological assessment
Authors: Aitken R J , Matley P J , Immelman E J 
Published: March 2007

Abstract
The aim of this study was to assess the long-term clinical and physiological sequelae of lower limb venous trauma in a civilian practice. Twenty-six patients who had undergone surgery for lower limb venous trauma (median elapsed time 19·5 months) underwent assessment. Injuries had been sustained to the external iliac, common femoral, superficial femoral and popliteal veins in two, four, nine and eleven limbs respectively. Using clinical assessment, photoplethysmography recovery time, the presence of popliteal reflux and venographic evidence of thrombosis, the final outcome was graded as good, fair or poor. Fourteen patients had pedal oedema, including two with a postphlebitic limb. The overall photoplethysmography recovery time (mean and s.d.) was 20·6 (8·7)s in the injured and 32·1 (6·7)s in the non-injured limbs (P = 0·002). Patients with a venographically occluded vein had a shorter photoplethysmography recovery time than those in whom the vein was patent (13·4 (5·6) versus 21·6 (8·7)s; P = 0·07). Popliteal reflux was present in 12 injured limbs. Seven of 12 venograms performed on limbs with a vein repair had evidence of previous thrombosis. Vein ligation carried considerable morbidity and all end-to-end anastomoses initially failed. In retrospect, saphenous vein grafts were too narrow for the recipient veins and panel grafts might have been more appropriate. Overall 11 of 26 patients (42 per cent) had a poor result. The repair of choice is a saphenous vein patch for lesser injuries and a saphenous panel graft for major injuries. Vein ligation should be avoided unless another life-threatening injury demands priority.
Ultrasonographic screening of the abdominal aorta among siblings of patients with abdominal aortic aneurysms
Authors: Bengtsson H , Norrgård Ö , Ängquist K A , Ekberg O , Öberg L , Bergqvist D 
Published: March 2007

Abstract
To evaluate the prevalence of abdominal aortic dilatations among asymptomatic brothers and sisters of patients with abdominal aortic aneurysms (AAAs), an ultrasonographic screening study was performed. One hundred and two siblings of patients operated on for AAAs at two Swedish hospitals were invited to attend, and 87 of them (35 men and 52 women) from 32 different families, accepted the invitation. Their median age was 63 years (range 39–82 years). Aortic dilatation was diagnosed in ten of the brothers (29 per cent) and three of the sisters (6 per cent). In ten cases (eight men and two women) there was a localized dilatation caudal to the coeliac axis, and in three a general dilatation of the abdominal aorta with the diameter at the coeliac axis &gt; 29 mm. None of the aortic dilatations had been known before this study was performed. The conclusion is that the prevalence of asymptomatic aortic dilatations among brothers of patients with AAAs seems to be high and that this group should be selected for further screening studies.
Acute ischaemia of the lower limb: The effect of centralizing vascular surgical services on morbidity and mortality
Authors: Clason A E , Stonebridge P A , Duncan A J , Nolan B , Jenkins A McL , Ruckley C V 
Published: March 2007

Abstract
Surgical audit data for two 5-year periods (1974–78 and 1983–87) have been compared in a Health Board Area to assess the impact of centralization of emergency vascular services on the treatment of the acutely ischaemic lower limb. Patient populations in each period were comparable. Mortality rates remained constant in both periods at approximately 30 per cent. A significant improvement in overall limb salvage was observed (from 54 to 67 per cent, P &lt; 0·05). Limb salvage in survivors was improved from 80 to 95 per cent (P &lt; 0·001) and was paralleled by an increase in the number of reconstructive vascular procedures performed. We concluded that the centralization of emergency vascular services has not led to a reduced risk of mortality but has been associated with improved limb salvage.
Anal and ileal pouch manometric measurements before ileostomy closure are related to functional outcome after ileal pouch—anal anastomosis
Authors: Scott N A , Pemberton J H , Barkel D C , Wolff B G 
Published: March 2007

Abstract
Anal canal length, anal canal resting and squeeze pressures, ileal pouch capacity and pouch compliance were measured in 104 patients after ileal pouch—anal anastomosis but before ileostomy closure. The intention was to determine if such parameters were associated with late functional outcome after re-establishment of intestinal continuity. Functional outcome in terms of stool frequency (day and night), incontinence (day and night), perianal pad use, perianal skin irritation, and the use of constipating agents was assessed for all 104 patients 1 year or more (median 438 days) after ileostomy closure. A low mean anal sphincter resting pressure before ileostomy closure was associated with subsequent nocturnal incontinence (P &lt; 0·05) and, to a lesser extent, the need to use constipating agents (P = 0·08). Pouch compliance if low before ileostomy closure was associated with an increased frequency of nocturnal stool frequency after 1 year (P &lt; 0·05). Anal canal length, anal sphincter squeeze pressure and pouch capacity before ileostomy closure were not related to subsequent functional outcome in these patients.
External and internal anal sphincter responses to rectal distension in normal subjects and in patients with idiopathic faecal incontinence
Authors: Bannister J J , Read N W , Donnelly T C , Sun W M 
Published: March 2007

Abstract
The responses of the external anal sphincter and the internal anal sphincter to rectal distension were studied in 18 female patients who had idiopathic faecal incontinence with perineal descent and 11 female control subjects, by measuring pressures at six sites within the anal canal and the electrical activity of the external sphincter. The pressure profile in the normal anal canal, at rest, was asymmetric with the highest pressure recorded in the outermost channels. Rectal distension caused a transient increase in the activity of the external sphincter, which was associated with an increase in anal pressure, particularly in the outermost two channels. This was followed by a symmetrical reduction in anal pressure throughout the anal canal, caused by relaxation of the internal sphincter and shortening of the high-pressure zone. Two patterns of response were observed in the patients with idiopathic incontinence. Twelve patients (group 1) showed normal anal relaxation, but the maximum anal pressures recorded during rectal distension or a conscious squeeze were abnormally low, suggesting weakness of the external anal sphincter. The remaining six subjects (group 2), who were older than the group 1 patients, had much lower resting pressures and showed only external sphincter contraction in response to rectal distension, with no obvious internal sphincter relaxation. However, the maximum pressures recorded during a conscious contraction of the external sphincter were lower in this group than in the normal control subjects. These results suggest that group 2 patients have impaired internal anal sphincter tone, as well as external anal sphincter weakness. This may explain why all except one of the group 2 patients, compared with only 17 per cent of group 1 patients, reported incontinence to both solids and liquids.
Ileitis and pouchitis after colectomy for ulcerative colitis
Authors: Scott A D , Phillips R K S 
Published: March 2007

AbstractIleitis can occur after surgical treatment of ulcerative colitis. Following continent ileostomy or restorative proctocolectomy ileitis can become a serious clinical problem and is then known as pouchitis although this condition is yet to be clearly defined. It is likely that pouchitis is the result of an abnormal host response to a change in bacterial flora and that the nature of this host response is related to the underlying pathogenesis of ulcerative colitis. Continued study of the immunological basis of ulcerative colitis is therefore required to solve the problem of pouchitis.
Follow-up of two treatment modalities for ductal cancer in situ of the breast
Authors: Arnesson L-G , Smeds S , Fagerberg G , Gröntoft O 
Published: March 2007

Abstract
In a mammography screening programme for the early detection of breast cancer 66 cases of ductal cancer in situ of the breast (DCIS) were diagnosed between 1978 and 1984 and prospectively followed up. In the beginning of the study period, DCIS was treated by mastectomy without axillary clearance but sector resection has been performed increasingly. Since 1982 the latter procedure has become standard treatment. Radical resection was confirmed by specimen X-ray and histopathological examination of whole organ sections. No postoperative radiotherapy was given. Twenty-eight women had mastectomy and 38 had sector resection. The median. follow-up times were 77 and 60 months respectively. In the mastectomy group postoperative monitoring did not reveal any local recurrence but one contralateral new invasive cancer was discovered. In the sector resection group five recurrences were found. Three of the latter were new cases of DCIS and two appeared as small invasive cancers (stage I). Mastectomy will cure ductal cancer in situ but has a greater morbidity. Sector resection has been established as the method of choice in stage I invasive cancer and is probably also safe in DCIS. The possible beneficial effect of postoperative local radiotherapy after sector resection for DCIS is currently being analysed in a randomized trial which started in Sweden in 1987.
High-output external fistulae of the small bowel: Management with continuous enteral nutrition
Authors: Lévy E , Frileux P , Cugnenc P H , Honiger J , Ollivier J M , Parc R 
Published: March 2007

Abstract
Three hundred and thirty-five patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Median fistula output was 1350 ml/24 h. Eighty-two per cent of patients were referred from other institutions. The fistula opening was associated with evisceration in 165 cases (49 per cent). One or more severity factors were present in 75.5 per cent of the patients. Patients were divided into three groups according to their initial therapy: 21 patients (6 per cent) referred in a moribund state were not operated on (non-intervention); 80 patients (24 per cent) were operated on as an emergency, and the fistula was either exteriorized or defunctioned; 234 patients (70 per cent) were initially managed conservatively. Appropriate local care and nutrition were provided in all cases. Enteral nutrition was the exclusive nutritional support in 285 patients (85 per cent). In 92 cases with proximal fistulae, methods limiting the fistula output or allowing reinfusion of chyme were required. The overall mortality rate was 34 per cent: 100 per cent in the non-intervention group, 55 per cent after emergency surgery, and 19 per cent after conservative treatment. In the latter group, spontaneous closure was obtained in 88 patients (38 per cent). Overall mortality rate was reduced to 19 per cent in patients treated since 1980. Enteral nutrition with appropriate local care may be used in the majority of high-output enterocutaneous fistulae, with an acceptable rate of spontaneous closure. Conservative management is the treatment of choice in the initial period. Emergency surgery should be restricted to the treatment of haemorrhage or intra-abdominal abscesses associated with uncontrolled systemic sepsis.
Colon interposition in children
Authors: Mitchell I M , Goh D W , Roberts K D , Abrams L D 
Published: March 2007

Abstract
Since 1960 we have performed 80 colonic interpositions on 79 children. We present a retrospective review of their progress. Sixty-nine interpositions were for long-gap oesophageal atresia, while the remainder followed oesophagectomies, eight for strictures and two others. Overall, the transthoracic route was used in 69 per cent of cases, while 29 per cent were retrosternally placed and one was retropleural. The mean follow-up was 11.08 years. The mortality rate was 12 per cent, with one-third of deaths unrelated to the operation. Graft failure, which occurred on eight occasions (10 per cent), was due to ischaemia in four, intractable stricture in two and stomal ulceration in two. Leakage from the proximal anastomosis occurred in 31 per cent of cases and stricture formation in 27 per cent. Thirty per cent of patients complained of acid reflux, of whom one-third developed stomal ulceration. We present data concerning other complications, including long-term recurrent respiratory infections, malabsorption, gastrointestinal haemorrhage, diarrhoea, intestinal obstruction and redundancy of the graft. Staging the procedure did not affect the outcome, however the higher incidence of serious complications encountered following retrosternal interposition finally led us to abandon this procedure in favour of the transthoracic route. There has been little improvement in the growth rate, but in terms of swallowing ability the outcome was satisfactory in 94 per cent of cases.
Umbilical sepsis
Authors: Sroujieh A S , Dawoud A 
Published: March 2007

Abstract
Pilonidal sinus of the umbilicus is rarely reported, and there are only 17 reported cases. On reviewing the records from Jordan University Hospital, 24 patients who were treated surgically for a discharging umbilical sinus were found. Three patients had known causes for their umbilical sepsis, namely stitch sinus, urachal remnant and an umbilical polyp. Of the remaining 21 patients, seven had clinical and pathological evidence of hair in their umbilicus. Most of our patients were young men who presented with discharge, soreness or pain, swelling, and cellulitis. Treatment by umbilical excision, leaving the skin defect to heal by secondary intention, proved satisfactory. The resultant scar resembles a normal umbilicus.