bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized, double-blind phase II trial of Lexipafant, a platelet-activating factor antagonist, in human acute pancreatitis
Authors: Kingsnorth A N , Galloway S W , Formela L J 
Published: March 2007

Abstract
The aims of the study were to determine whether the platelet-activating factor antagonist Lexipafant could alter the clinical course and suppress the inflammatory response of human acute pancreatitis. In a double-blind, placebo-controlled study 83 patients were randomized to receive Lexipafant 60 mg intravenously for 3 days, or placebo. Clinical progression was assessed by daily Acute Physiology And Chronic Health Evaluation (APACHE) II score and organ failure score (OFS). The magnitude of the inflammatory response on days 1–5 was assessed by serial measurement of interleukin (IL) 8, IL-6, E-selectin, polymorphonuclear elastase-alpha1-antitrypsin (PMNE-α1-AT), and C-reactive protein (CRP). At entry, patients receiving Lexipafant (n = 42) or placebo (n = 41) were matched for age and sex, aetiology, APACHE II score and OFS. The disease was classified as severe in 29 patients (APACHE II score eight or more). There was a significant reduction in the incidence of organ failure (P = 0±041) and in total OFS (P=0±048) at the end of medication (72 h). During this time seven of 12 patients with severe acute pancreatitis who had Lexipafant recovered from an organ failure; only two of 11 with severe acute pancreatitis who had placebo recovered from an organ failure and two others developed new organ failure. Lexipafant treatment significantly reduced serum IL-8 (P = 0±038), and IL-6 declined on day 1. Plasma PMNE-α1-AT complexes peaked on day 1; the gradual fall to baseline over 5 days observed in controls did not occur in patients given Lexipafant. No effect was observed on serum CRP. This study provides a rationale for further clinical trials with the potent PAF antagonist Lexipafant in human acute pancreatitis.
Physiological changes after Delorme's procedure for full-thickness rectal prolapse
Authors: Plusa S M , Charig J A , Balaji V , Watts A , Thompson M R 
Published: March 2007

Abstract
Anal sphincter pressures, rectal compliance and sensation in 19 women of mean age 77 (range 57–94) years were studied before and after Delorme's procedure for full-thickness rectal prolapse. No patient had significant problems with defaecation after operation. There were no significant changes in anal sphincter pressures but the volume of first rectal sensation decreased from a median of 140 ml before surgery to 65 ml after the procedure (P = 0·01) and the maximum tolerated rectal volume declined from a median of 249 ml to 120 ml (P = 0·001). Rectal compliance was reduced from a median of 142.9 ml/kPa to 12.2 ml/kPa (P = 0·002). Improved rectal sensation and lowered compliance are associated with a reduced incidence of defaecatory problems after Delorme's procedure.
The Edinburgh randomized trial of axillary sampling or clearance after mastectomy
Authors: Forrest A P M , Everington D , McDonald C C , Steele R J C , Chetty U , Stewart H J 
Published: March 2007

Abstract
Between January 1980 and October 1983, 417 patients were randomized for mastectomy followed by axillary node sampling or full axillary clearance. The aim of the study was to determine whether a standard ‘four-node’ axillary sample, followed by careful dissection of removed tissue, could accurately indicate the extent of local treatment required. Axillary radiotherapy was given only to patients with histological involvement of sampled nodes and not to any having axillary clearance. The incidence of involved nodes was similar for both groups, as were distant relapse and survival rates. Currently 62.6 per cent are alive after clearance and 65.0 per cent after sampling. A non-significant increase in the rate of locoregional relapse was observed for those treated by axillary node clearance, this being due mainly to increased relapse on the unirradiated chest wall (clearance 21 per cent versus sampling 12 per cent in patients with node-positive disease). There was only a minor difference in axillary relapse, favouring axillary clearance (3.0 versus 5.4 per cent). In patients with operable breast cancer, mastectomy with axillary node sampling gives equal control to mastectomy with axillary node clearance but, as morbidity is greater, surgical clearance of the axilla is the preferred option.
Long-term follow-up of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ
Authors: Hammarström L-E , Holmin T , Stridbeck H , Ihse I 
Published: March 2007

Abstract
Eighty-three patients with bile duct calculi were entered in a prospective randomized study of endoscopic sphincterotomy (ES) and stone removal (group 1) versus surgery alone (group 2), and were followed for more than 5 years. In group 1 endoscopic stone clearance was successful in 35 of 39 patients. Thirteen patients subsequently had cholecystectomy with (n = 7) or without (n = 6) biliary symptoms and one had a cholecystostomy for acute cholecystitis. Two patients have had mild biliary colic or pancreatitis. Two patients died from gallbladder carcinoma after 9 days and 18 months. In group 2 bile duct stones were cleared surgically in 37 of 41 patients. Late complications occurred in two patients (incisional hernia and recurrent stone). One patient with gallbladder carcinoma was cured and another died after 16 months. Early major and minor complications occurred in three and four respectively of 39 patients in group 1, and in three and six respectively of 41 patients in group 2. There were no deaths. During follow-up the total morbidity rate reached 28 per cent (11 of 39) and 5 per cent (two of 41) (P = 0.005) and the non-biliary related mortality rate was 31 per cent (12 of 39) and 10 per cent (four of 41) (P = 0.02) in groups 1 and 2 respectively. Nine patients in group 1 and two in group 2 died from heart disease (P = 0.02). Total hospital stay was 2–42 (median 13) days and 6–36 (median 16) days in groups 1 and 2 respectively (P not significant). Endoscopic and surgical treatment of bile duct calculi in middle-aged and elderly patients with gallbladder in situ are equally effective in the long term. However, the significantly increased mortality rate from heart disease in patients treated endoscopically compared with those treated surgically might speak in favour of operation.
Clinical biology of nitric oxide
Authors: Davies M G , Fulton G J , Hagen P-O 
Published: March 2007

Abstract
Nitric oxide is a pluripotential molecule that acts as both an autocrine and paracrine mediator of homoeostasis, and derangement of its metabolism can be linked with many pathophysiological events. This review provides a broad overview of the basic and clinical scientific aspects of nitric oxide.
Single-stage treatment for malignant left-sided colonic obstruction: A prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation
Authors:   The SCOTIA Study Group, Ross S , Krukowski Z H , Munro A , Russell I T 
Published: March 2007

Abstract
This multicentre study is the first prospective randomized trial to compare subtotal colectomy with segmental resection and primary anastomosis following intraoperative irrigation for the management of malignant left-sided colonic obstruction. Of the 91 eligible patients recruited by 12 centres, 47 were randomized to subtotal colectomy and 44 to on-table irrigation and segmental colectomy. Hospital mortality and complication rates did not differ significantly, but 4 months after operation increased bowel frequency (three or more bowel movements per day) was significantly more common in the subtotal colectomy group (14 of 35 versus four of 35, χ2 = 6·06, 1 d.f., P = 0·01). More patients in the subtotal colectomy group reported that they had consulted their general practitioner with bowel problems than did those in the segmental resection group (15 of 37 versus three of 35, χ2 = 8·17, 1 d.f., P = 0·004). Segmental resection following intraoperative irrigation is the preferred option except when there is caecal perforation or if synchronous neoplasms are present in the colon, when subtotal colectomy is more appropriate.
Experience with ileostomy and colostomy in Crohn's disease
Authors: Post S , Herfarth Ch , Schumacher H , Golling M , Schürmann G , Timmermanns G 
Published: March 2007

Abstract
This study involved 746 patients with Crohn's disease treated surgically within a 13-year interval in whom 227 stomas (159 primary, 68 secondary) were created. The main indication (64 per cent) for primary stoma was severe perianal or genital fistulous disease. Revisional surgery for stomal complications was more common following colostomy than ileostomy (31 versus 5 per cent, P &lt; 0.01). Twenty years after the first symptoms of Crohn's disease the cumulative risks of receiving any stoma or a permanent stoma were 41 and 14 per cent respectively. Four parameters were shown by proportional hazards analysis to be independently associated with the risk for any stoma as well as a permanent one; increased risk coincided with rectal inflammation, perianal fistula or abscess, and absence of small intestinal involvement. In addition, long-standing symptomatic disease before the first surgical intervention reduced the risk of a permanent stoma. The long-term chances of closure following temporary stoma were 75 per cent when used for ana-stomotic protection or avoidance, 79 per cent after postoperative complications, and 40 per cent for perianal or genital fistulas or for rectal inflammation or stenosis. Rectal disease and perianal fistula were the only independent predictors of a low possibility of stoma closure during follow-up.
Non-inflammatory rectovaginal fistula
Authors: Watson S J , Phillips R K S 
Published: March 2007

Abstract
The results of surgical repair of straightforward rectovaginal fistula in 26 women (obstetric, 13; infection, nine; trauma, one; unknown but not radiation-induced or related to inflammatory bowel disease, three) were ultimately excellent; 23 patients were cured. However, this result obscures a high early failure rate in five of 12 patients having a transanal advancement flap and in one of eight having perineoproctotomy (lay open and repair). A temporary stoma was used in 11 patients (five of eight with a perineoproctotomy, three of 12 with an advancement flap and in three having another local procedure).
Intracaval ultrasonography in the diagnosis of tumour involvement of the vena cava
Authors: Kaneko T , Nakao A , Funahashi H , Itoh S , Endo T , Harada A , Nonami T , Takagi H 
Published: March 2007

Abstract
A retrospective study of 34 consecutive patients with possible tumour involvement of the vena cava was performed to assess the usefulness of intracaval ultrasonography. Twenty-five of the 34 patients were operated and resection carried out in 23, including seven with combined resection of the vena cava. The sonographic criterion for vena cava invasion was obliteration of the echogenic ring of the vena cava wall or intracaval tumour mass. The sensitivity, specificity and overall accuracy of intracaval endovascular ultrasonography in the diagnosis of tumour involvement of the vena cava were 100, 96 and 97 per cent respectively. The respective values were 91, 61 and 71 per cent for computed tomography and 82, 67 and 72 per cent for cavography. Ultrasonography is a useful technique that can precisely evaluate the vena cava for possible tumour invasion, especially when the presence or extent of tumour involvement is not definitely established by conventional imaging techniques.
Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans
Authors: Sedman P C , MacFie J , Palmer M D , Mitchell C J , Sagar P M 
Published: March 2007

Abstract
Concerns have recently been expressed at suggestions that postoperative sepsis may be more common in patients who have received preoperative total parenteral nutrition (TPN). The mechanism suggested for this is that TPN causes intestinal mucosal atrophy leading to increased bacterial translocation from the gut as a source of systemic sepsis. This hypothesis was examined in 203 patients who had an elective laparotomy, 28 of whom required at least 10 days of preoperative TPN. Neither mucosal atrophy nor bacterial translocation was more common in parenterally fed patients than in enterally fed controls. In humans theoretical concerns about the adverse effects of TPN on intestinal integrity are unfounded.
Self-expanding metal stents for the palliation of dysphagia due to inoperable oesophageal carcinoma
Authors: Ellul J P M , Watkinson A , Khan R J K , Adam A , Mason R C 
Published: March 2007

Abstract
Adequate palliation of dysphagia due to inoperable oesophageal carcinoma is difficult to achieve with low morbidity. Thirty-three patients (21 men and 12 women of mean(s.e.m,) age 69(2) years) with inoperable carcinoma of the oesophagus underwent insertion of self-expanding metal stents. In 22 patients the tumours were in the lower third of the oesophagus, in eight in the middle third and in three in the upper third. A stent was inserted as primary palliative therapy in 14 patients, after failed laser therapy in 13 and after oesophageal perforation following other treatments in six. Patients presented with dysphagia of grade 3 or 4. Three types of stent were used: Wallstent, Strecker and Gianturco; stents were inserted under fluoroscopic guidance after balloon dilatation of the stricture. All attempted insertions of metal stents were successful. Dysphagia reduced from grade 3 or 4 to 0 or 1. There were no perforations related to insertion. Patients who had stents inserted to seal previous perforations left hospital a median 7 days later. Dysphagia recurred in six patients, due to migration of the stent (three), blockage by food bolus (one) and tumour overgrowth (two). These problems were easily treated. Self-expanding metal stents seem to offer excellent palliation with minimal morbidity for patients with inoperable carcinoma of the oesophagus.
Prognostic factors after resection of ampullary carcinoma: Multivariate survival analysis in comparison with ductal cancer of the pancreatic head
Authors: Klempnauer J , Ridder G J , Pichlmayr R 
Published: March 2007

Abstract
Resection was performed in 85 patients with ampullary and in 150 with ductal pancreatic head carcinoma. Curative resection was achieved in 98 and 87 per cent respectively. Patient survival at 5 years after exclusion of hospital deaths was 38 versus 16 per cent respectively. The patients were compared retrospectively in a multivariate survival analysis. For patients with pancreatic carcinoma, residual tumour stage, tumour size and grading were independent prognostic factors, but for those with ampullary carcinoma only tumour size was a prognostic factor. Lymph node metastasis impaired prognosis, but this effect was demonstrable for both groups only after univariate analysis. The Union Internacional Contra la Cancrum classification system was not a reliable parameter of prognosis after resection of ampullary carcinoma. Patients with ampullary cancer appear to have a better prognosis intrinsically than those with pancreatic head tumours, and not simply because they present at an earlier stage. The difference in prognosis cannot be explained sufficiently by a differential importance of the various survival variables.
Increased monocyte cytokine production in association with systemic complications in acute pancreatitis
Authors: McKay C J , Gallagher G , Brooks B , Imrie C W , Baxter J N 
Published: March 2007

Abstract
Tumour necrosis factor (TNF) α, interleukin (IL) 1β, IL-6 and IL-8 are thought to play a central role in the pathophysiology of sepsis but their role in acute pancreatitis is unknown. In the present study, monocytes were isolated from the peripheral blood of 26 patients with moderate or severe acute pancreatitis without biliary sepsis. Secretion of these cytokines in vitro was measured at intervals during the first week of illness. Sixteen patients developed systemic complications. Peak TNF-α secretion was significantly higher in patients who developed systemic complications (median (interquartile range (i.q.r.)) 18·05 (5·5–28·5) ng/ml) than in those with an uncomplicated course (3·7 (2·3–6·4) ng/ml, P&lt; 0·01). Similarly, peak IL-6 and peak IL-8 secretion were significantly higher in the complicated group (IL-6: complicated median (i.q.r.) 48·9 (12·1–71·0) ng/ml, uncomplicated 16·3 (14·2–37·9) ng/ml, P&lt; 0·05; IL-8: complicated 748 (643–901) ng/ml, uncomplicated 608 (496–749) ng/ml), P&lt;0·05). No significant difference in peak IL-1β secretion was observed between the two groups. Systemic complications of acute pancreatitis are associated with a significant increase in monocyte secretion of TNF-α, IL-6 and IL-8 suggesting that, as in sepsis, these cytokines play a central role in the pathophysiology of the disease.
Surgical strategy and management of infected pancreatic necrosis
Authors: Farkas G , Márton J , Mándi Y , Szederkényi E 
Published: March 2007

Abstract
Infected pancreatic necrosis and sepsis are the leading causes of death in patients with necrotizing pancreatitis. Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was performed a mean of 18·5 days after the onset of acute pancreatitis. Operative management consisted of wide-ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39·5 days, with a median of 6·5 litres of normal saline per day. In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed. Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients. The overall hospital mortality rate was 7 per cent (nine patients died). Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, longstanding lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication.
Operative strategies in pancreatic trauma
Authors: Farrell R J , Krige J E J , Bornman P C , Knottenbelt J D , Terblanche J 
Published: March 2007

Abstract
Pancreatic injuries are relatively uncommon and the choice of an appropriate operative procedure can be difficult. Operations for pancreatic trauma from January 1990 to June 1993 have been reviewed. Fifty-one patients were studied; 13 had blunt trauma, 17 gunshot wounds and 21 stab wounds. The distribution of injuries was: pancreatic head (17), body (15) and tail (19). Most patients had associated injuries of surrounding organs. Operations performed included pancreatoduodenectomy (seven), distal pancreatectomy (seven) and external drainage (35). Five patients (10 per cent) died: two from haemorrhage, one from an acute subdural haematoma and two from multiple organ failure. Ten patients (20 per cent) developed a pancreatic fistula, four following blunt trauma, four after gunshot wounds and two with stab wounds; all but one had undergone drainage procedures. Stab wounds were associated with a low incidence of duct injury and external drainage was usually satisfactory. After blunt trauma and gunshot wounds, duct injuries were common and easily missed; careful exploration by an experienced surgeon is essential. In appropriately selected patients, pancreatic resection can be performed with good result.
Randomized comparison of pulmonary function after the ‘French’ and ‘American’ techniques of laparoscopic cholecystectomy
Authors: Kum C-K , Eypasch E , Aljaziri A , Troidl H 
Published: March 2007

Abstract
The ‘French’ and ‘American’ techniques of laparoscopic cholecystectomy, which differ in the position of the surgeon and ports, have not been compared directly. The authors' hypothesis was that the ‘French’ technique results in better postoperative pulmonary function than the ‘American’ technique. Patients undergoing elective cholecystectomy were randomized, 25 patients to have the ‘French’ method and 24 the ‘American’ method. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured before operation, and 6, 24 and 48 h after surgery. Postoperative pain and fatigue were also measured. Both FVC and FEV1 at 6 h, 24 h and 48 h after operation were significantly less in the ‘American’ group (FVC at 24 h: 71 versus 86 per cent of preoperative value; P = 0·001, Student's t test; 95 per cent confidence interval 7–24). Two cases of atelectasis occurred in the ‘American’ group and none in the ‘French’ group. Differences in access to Calot's triangle were also noted. One patient in the ‘French’ group sustained a diathermy injury of the duodenum, related to defective equipment. It is concluded that the ‘French’ method leads to less impairment of pulmonary function.
Changes in the management of critical limb ischaemia
Authors: Varty K , Nydahl S , Butterworth P , Errington M , Bolia A , Bell P R F , London N J M 
Published: March 2007

Abstract
A prospective study of all patients with critical limb ischaemia (CLI) who presented to a single vascular unit was undertaken for a 12-month period. There were 222 referrals in 188 patients, 80·2 per cent of which were emergency or urgent admissions. The majority (72·5 per cent) were initially investigated with colour duplex scanning to characterize the arterial lesion. Diagnostic angiography was performed in 35·1 per cent. An attempt at revascularization was made in 73·0 per cent of cases using percutaneous transluminal angioplasty (PTA) in 42·3 per cent, surgery in 24·3 per cent, and a combination of surgery and PTA in 6·3 per cent. Primary major amputation was required in 22 cases (9·9 per cent) and conservative treatments were used in 38 (17·1 per cent). The in-hospital mortality rate was 10 per cent with a limb salvage rate of 79 per cent. Diabetes was an independent risk factor for amputation (odds ratio 2·4, 95 per cent confidence interval 1·22–4·79, P = 0·012). Median hospital stay was much shorter for patients treated by PTA (4·5 days) than surgery (16 days) or primary amputation (18 days). The complication rate of PTA requiring surgery was 5·5 per cent. CLI represents a large non-elective workload for a vascular unit. The increasing use of non-invasive duplex assessment and angioplasty plays a major part in the successful management of these patients.
Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: Comparison of straight and colonic J pouch anastomoses
Authors: Ho Y-H , Tan M , Seow-Choen F 
Published: March 2007

Abstract
Clinical function and anorectal physiology were studied prospectively in patients with rectal cancer after low anterior resection, randomized to either a straight anastomosis or an 8-cm colonic J pouch anastomosis. Sixteen patients (mean(s.e.m.) age 61·2(3·2) years; ten men, six women) had a straight anastomosis and 17 (mean(s.e.m.) age 61·2(3·8) years; six men, 11 women) a colonic pouch anastomosis. At 1 year after low anterior resection, a bowel function questionnaire was administered and anorectal physiology tests were performed. Patients with a straight anastomosis had significantly more frequent stools (median 6 (range 3–7) daily) compared with those who had a pouch (median 3 (range 2–7) daily; P = 0·02). A frequent sensation of incomplete defaecation was found in three patients with a straight anastomosis compared with ten who had a pouch anastomosis (P = 0·02). The mean resting anal pressures were lower after colonic pouch anastomosis (P = 0·049) but there were no differences in anal squeeze pressure, rectal sensation, volume of first sensation and compliance between the two groups. The decreased stool frequency with an 8-cm colonic pouch was not associated with measured improvements in rectal reservoir function. It is possible that reversed propulsive activity may be important in smaller colonic J pouches.