bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histological assessment of the distal ‘doughnut’ in patients undergoing stapled restorative proctocolectomy with high or low anal transection
Authors: Deen K I , Hubscher S , Bain I , Patel R , Keighley M R B 
Published: March 2007

Abstract
A non-randomized prospective study of 38 patients, 32 with ulcerative colitis and six with familial adenomatous polyposis (FAP), who underwent high or low anal transection during stapled restorative proctocolectomy was undertaken. The median (range) height of the staple line 6 months after operation was 5·2 (3·2–6·0) cm after high transection compared with 2·9 (1·8–3·6) cm after low transection. Nineteen of 20 patients after high anal transection had columnar epithelium in the distal ‘doughnut’ versus 16 after low transection. Active colitis was present in 12 of 19 ‘doughnuts’ in patients with high anal transection and columnar mucosa and in seven of 16 after low transection. Nine patients (high transection two, low transection seven; P &lt; 0·05) had striated muscle in the stapled distal ‘doughnut’. Dysplasia was found in the resected colon in one patient with ulcerative colitis and adenocarcinoma in two colectomy specimens (ulcerative colitis, one; FAP, one). No dysplasia or carcinoma was seen in any of the ‘doughnuts’ from patients with ulcerative colitis. Four patients with FAP (high transection, two; low transection, two) had microadenoma in the distal ‘doughnut’. Despite attempts to place a stapled pouch-anal anastomosis below the anal transition zone, it was not possible to remove columnar mucosa completely from the remaining anal canal in most patients (16 of 18). High anal transection and pouch-anal anastomosis should be the preferred option in restorative proctocolectomy, as a dentate-line anastomosis may not fully eliminate columnar epithelium and may involve resection of some of the external sphincter.
Requirement for bowel preparation in colorectal surgery
Authors: Burke P , Mealy K , Gillen P , Joyce W , Traynor O , Hyland J 
Published: March 2007

Abstract
To determine whether mechanical bowel preparation influences the incidence of anastomotic dehiscence following colorectal surgery, 186 patients undergoing elective left colonic or rectal resection were randomized before surgery to bowel preparation (n = 89) or no bowel preparation (n = 97). Surgical technique was standardized and no patient had a defunctioning colostomy. Seventeen patients were excluded (seven with preparation, ten without). Indications for surgery in the remaining 169 patients were carcinoma (133 patients), diverticular disease (26), inflammatory bowel disease (six) and miscellaneous conditions (four). Operations performed were left colonic resection or reversal of Hartmann's procedure (26 with preparation, 28 without) and anterior resection (56 versus 59). The overall morbidity rate (18 per cent) was similar in the two groups. All seven clinical anastomotic leaks occurred after low anterior resection, in three of the 39 patients who had undergone bowel preparation and four of the 36 who had not (P &gt; 0·9). Two deaths occurred, both of patients who had received bowel preparation, one being secondary to anastomotic leakage. Bowel preparation does not influence outcome after elective colorectal surgery.
Magnetic resonance imaging of rectal carcinoma: A prospective study
Authors: McNicholas M M J , Joyce W P , Dolan J , Gibney R G , MacErlaine D P , Hyland J 
Published: March 2007

Abstract
Accurate preoperative staging of rectal cancer is necessary to identify patients who might benefit from adjuvant therapy. Magnetic resonance imaging (MRI) was evaluated in 20 consecutive patients with rectal cancer undergoing ‘curative’ surgery. Detailed histopathological examination of the resected lesion was correlated with findings of MRI. MRI staging concurred with histological staging in 18 of 20 patients using the Dukes or tumour node metastasis classification but in only 14 using the modified Astler–Coller system. MRI diagnosed transmural invasion in all but one patient with microscopic mural invasion (positive predictive value, 100 per cent; negative predictive value, 80 per cent; overall accuracy, 95 per cent). MRI correctly diagnosed tumour deposits or involved lymph nodes in 12 patients. MRI overstaged one paticnt, in whom nodes that were enlarged on imaging studies were negative at histological examination (positive predictive value, 92 per cent; negative predictive value, 100 per cent; overall accuracy, 95 per cent). MRI has a role in selected cases for the preoperative assessment of rectal carcinoma.
Bowel ischaemia and organ impairment in elective abdominal aortic aneurysm repair
Authors: Soong C V , Blair P H B , Halliday M I , McCaigue M D , Hood J M , Rowlands B J , Barrosd'sa A A B 
Published: March 2007

Abstract
In 30 patients undergoing elective repair of abdominal aortic aneurysm the intramucosal pH (pHi) of the sigmoid colon was measured. Blood for endotoxin assay was taken at intervals before, during and after surgery. Daily measurements were made of liver transaminase activity and of arterial partial pressure of oxygen (PaO2). The mean(s.e.m.) peak systemic endotoxin concentration in those who developed intramucosal acidosis (pHi below 7·00) was 90(14) pg/ml, compared with 42(5) pg/ml in those who did not (P &lt; 0·01). In the 14 patients whose pHi fell below 7·00, the mean(s.e.m.) postoperative rise in aspartate transaminase activity was 346(74) per cent, compared with 181(20) per cent in those whose pHi remained above this level (P &lt; 0·05). The mean(s.e.m.) postoperative ratio of PaO2, to the fraction of inspired oxygen was 177(11) mmHg in those with intramucosal acidosis, compared with 260(24) mmHg in those whose pHi remained above 7·00 (P &lt; 0·01). These results demonstrate a relationship between bowel ischaemia, endotoxaemia and organ impairment following elective aneurysm repair.
Elbow arteriovenous fistulas for chronic haemodialysis
Authors: Elcheroth J , de Pauw L , Kinnaert P 
Published: March 2007

Abstract
Arteriovenous fistulas (AVFs) were created at the elbow, rather than using prosthetic grafts, when forearm vessels were inadequate. A total of 272 such fistulas were constructed: 49 between the brachial artery and a forearm vein, 91 between the brachial artery and the elbow perforating vein, 52 between the brachial artery and the cephalic vein and 80 between the brachial artery and the basilic vein. In each case the vein was sutured end to side to the artery. The immediate failure rate was 11·8 per cent. The 1- and 4-year cumulative patency rates were 68·7 and 51·2 per cent for brachial artery-forearm vein AVFs, 80·3 and 68·0 per cent for those between the brachial artery and the elbow perforator, 74·1 and 61·3 per cent for brachial artery-cephalic vein fistulas, and 76·7 and 49·2 per cent for those between the brachial artery and the basilic vein. The elbow AVF is a reliable means of establishing vascular access for haemodialysis.
Triple therapy and incidence of de novo cancer in renal transplant recipients
Authors: Kehinde E O , Petermann A , Morgan J D , Butt Z A , Donnelly P K , Veitch P S , Bell P R F 
Published: March 2007

Abstract
Some 27 (5·5 per cent) of 492 renal transplant recipients developed de novo cancer between January 1975 and December 1991. Patients administered triple therapy of prednisolone, cyclosporin A and azathioprine had a significantly higher incidence of cancer (seven of 40 patients; 17·5 per cent) than those given prednisolone with cyclosporin (14 of 319; 4·4 per cent) and azathioprine with prednisolone (six of 133; 4·5 per cent) (P= 0·005). In a prospective study between January 1989 and December 1992, 110 renal transplant patients were randomized into three immunosuppressive regimens at the time of transplantation. The incidence of cancer in patients receiving low-dose cyclosporin, azathioprine and prednisolone was three of 45, in those given high-dose cyclosporin and prednisolone none of 23 and in those administered high-dose cyclosporin, nifedipine and prednisolone one of 29. The addition of azathioprine to ongoing maintenance cyclosporin and prednisolone therapy is useful in a subgroup of patients with graft dysfunction, but there are possibly higher risks in the development of de novo carcinoma.
Administration of heparin and antibiotic prophylaxis
Authors: Avery C M , Jamieson N V , Calne R Y 
Published: March 2007

Abstract
An audit was performed to examine the time of administration of heparin and antibiotic prophylaxis to patients at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The records of 648 consecutive patients undergoing major surgery within a 12-month period were reviewed retrospectively. Heparin prophylaxis was given before surgery to only 30·9 per cent of patients undergoing elective procedures and in only 22·7 per cent of emergencies. Antibiotic prophylaxis was given before operation or at induction of anaesthesia to 82·1 per cent of patients undergoing elective procedures and in only 72·1 per cent of emergencies. It is concluded that administration of heparin and antibiotic prophylaxis is inadequate despite the provision of a written protocol.
Prognostic variables in patients with gastrointestinal carcinoid tumours
Authors: McDermott E W M , Guduric B , Brennan M F 
Published: March 2007

Abstract
Prognostic variables in patients with gastrointestinal carcinoid tumour were studied with a view to identifying those most likely to benefit from aggressive therapy. A total of 188 patients were studied; the median follow-up of those surviving was 72 months. On univariate analysis variables of prognostic significance were sex (P &lt;0·01), site of the primary tumour (P &lt;0·01), depth of invasion (P &lt;0·001), tumour size (P &lt;0·005), presence of lymph node (P &lt;0·001) or liver (P &lt;0·001) metastases, mode of discovery (P &lt;0·001) and operative intent (P &lt;0·001). On multivariate analysis the variables independently predictive of death from disease were sex (women have a better prognosis) and presence of metastases at the time of diagnosis.
Reversal of jejunoileal bypass in patients with morbid obesity
Authors: Anderson P E , Pilkington T R E , Gazet J-C 
Published: March 2007

Abstract
Jejunoileal bypass for morbid obesity was performed on 182 patients between 1971 and 1982. At 19 years' follow-up 60 (33 per cent) have had to undergo reversal. The compelling reasons for reversal were life-threatening malnutrition, immune complex disease, renal oxalate stones, osteomalacia and severe electrolyte disturbance. All patients gained weight after reversal of the jejunoileal bypass; most gained all the weight they had lost. Thirty-one patients returned to grade III obesity and 14 to grade II. Twelve patients had an associated vertical gastroplasty: ten regained their previous weight and only two stayed within normal weight. Patients were generally free from bypass-associated symptoms and complications apart from arthralgia and arthritis. This report concludes a series of articles published by the authors on jejunoileal bypass over the past 20 years describing the rise and fall of this surgical procedure.
Resection for extrahepatic recurrence of hepatocellular carcinoma
Authors: Lo C M , Lai E C S , Fan S T , Choi T K , Wong J 
Published: March 2007

Abstract
A total of 277 patients with hepatocellular carcinoma (HCC) underwent hepatic resection over a 20-year period. Twelve of 36 patients with recurrence confined to extrahepatic organs underwent surgical resection. There were no complications but one patient died in hospital from secondary intrahepatic recurrence. The 1-, 2- and 5-year survival rates for these 12 patients after hepatic resection were 92, 52 and 26 per cent respectively and were better than those of 24 patients who did not undergo resection for recurrence. The mean survival following resection for recurrent disease was 19·7 months and the longest survival time was nearly 8 years. Secondary recurrence after resection of metastases developed more commonly in the liver than in extrahepatic organs. Among the eight patients who survived for more than 4 months after the second operation, secondary recurrence developed in the liver and extrahepatic organs in eight and four patients respectively. In selected patients with isolated extrahepatic recurrence of HCC, surgery is effective in controlling extrahepatic disease and offers the only chance of long-term survival.
Civilian and war injuries of the perineum and anal sphincters
Authors: Engel A F , Kamm M A , Hawley P R 
Published: March 2007

Abstract
Patients with pelvic and perineal non-obstetric trauma were studied to determine the clinical outcome in relation to faecal continence. Between 1980 and 1992, 65 patients were referred for post-traumatic assessment of the anal sphincters and continence mechanism. All patients were continent before trauma. Using clinical examination, manometry, concentric-needle electromyography and most recently anal endosonography, external sphincter defects were identified in 56 patients, of whom 52 underwent overlapping sphincter repair. The external sphincter was considered to be intact in nine patients. At a median follow-up of 12 months a good result (continence grades 1 and 2) was achieved in 36 of 52 patients and a poor outcome (continence grades 3 and 4) in ten; six patients were lost to follow-up. A good clinical result was associated with a significant increase in resting pressure (median increase 15 cm H2O; P = 0·017) and squeeze pressure (median increase 35 cmH2O; P = 0·001). At postoperative assessment three patients with a poor outcome were shown to have a second unsuspected contralateral sphincter defect that had not been repaired. Physiological and endosonographic investigation combined with late surgical repair leads to a good outcome in most patients with traumatic sphincter damage.
Wedge resection alone or combined with segmental phenolization for the treatment of ingrowing toenail
Authors: Fulton G J , O'Donohoe M K , Reynolds J V , Keane F B V , Tanner W A 
Published: March 2007

Abstract
A retrospective analysis was undertaken of 387 patients treated surgically for ingrowing toenail between 1987 and 1989. In all, 203 patients were assessed and had 309 procedures performed on the median and/or lateral margins of one or both halluces. The procedures were performed by all grades of surgeon. A total of 126 wedge resections and 183 wedge resection-segmental phenolization combination treatments were performed. There were significantly fewer recurrences in the group receiving combination treatment (eight; 4·4 per cent) than in that having wedge resection alone (22; 17·5 per cent) (P &lt; 0·001). Patients having procedures performed by senior house officers had a significantly greater chance of recurrence if a wedge resection alone was performed. It is concluded that the combination procedure gives better long-term results than wedge resection alone and can be used successfully by all grades of surgeon.
Endovascular repair of abdominal aortic aneurysm: Limitations of the single proximal stent technique
Authors: Sayers R D , Thompson M M , Nasim A , Bell P R F 
Published: March 2007

Abstract
Endovascular repair of abdominal aortic aneurysm (AAA) has been performed using both a single proximal stent technique and a double (proximal and distal) stent method to anchor a graft in the aneurysm lumen. This study examined the effect of the single proximal stent technique on femoral artery blood flow, renal function and the occurrence of back-bleeding into the aneurysm sac in a canine model; eight dogs were used. Femoral artery blood flow and glomerular filtration rate were not affected by graft–stent insertion. Two graft–stent combinations failed to deploy in the correct position and led to graft thrombosis in one case. The six correctly positioned grafts all showed back-bleeding from around the distal end into the aneurysm sac. The single proximal stent technique for endovascular repair of AAA is inadequate and attention should continue to focus on a double (proximal and distal) stent method or a bifurcated system.
Screening for abdominal aortic aneurysm: A single scan is enough
Authors: Emerton M E , Shaw E , Poskitt K , Heather B P 
Published: March 2007

Abstract
A group of 223 men who were found to have a normal abdominal aortic diameter (less than 2·6 cm) at the age of 65 or 66 years when first examined by ultrasonography in 1988 was studied again 5 years later. Twenty-seven patients had died, none from confirmed aneurysm rupture, and repeat scans were obtained in 189 of the 196 survivors. A further patient was reassessed at laparotomy. Mean aortic diameter was unchanged during the intervening 5 years and 166 of 189 repeat scan measurements were within 3 mm of the original value. Only two patients were found to have an aortic diameter of 3 cm or more on rescanning. These results suggest that a single ultrasonographic examination at the age of 65 years can safely be used to exclude over 90 per cent of those examined from future risk of significant aneurysmal dilatation of the aorta, with important cost and organizational benefits for a population screening programme.
Impaired homocysteine metabolism: A risk factor in young adults with atherosclerotic arterial occlusive disease of the leg
Authors: Aronson D C , Onkenhout W , Raben A M T J , Oudenhoven L F I J , Brommer E J P , van Bockel J H 
Published: March 2007

Abstract
To assess the prevalence of impaired homocysteine metabolism in young adults with arterial occlusive disease, 80 consecutive patients under 45 years old were screened. Various laboratory blood investigations and a standardized methionine loading test were performed. In the first 52 patients plasma levels of free homocysteine were determined; thereafter the levels of total homocysteine (a more sensitive measure of impaired homocysteine metabolism) were measured. The methionine loading test was abnormal in 15 patients (19 per cent) who did not differ from the other 65 with respect to prevalence of other risk factors, clinical characteristics, and electrocardio-graphic and angiographic findings. Blood levels of glucose, vitamins B6 and B12, folate, protein C and protein S, fibrinogen and low-density lipoprotein cholesterol did not differ significantly between the two groups. The prevalence of impaired homocysteine metabolism in young patients with arterial occlusive disease is greater than the 1–2 per cent found in the normal population.
Effect of pulsatile shear stress on endothelial attachment to native vascular surfaces
Authors: Thompson M M , Budd J S , Eady S L , James R F L , Bell P R F 
Published: March 2007

Abstract
An in vitro model of vascular damage was used to investigate the ability of seeded endothelial cells to resist shear stresses generated in a perfusion circuit. At perfusion rates of 100 ml/min the maximum shear stress reached 16.5 dyn/cm2. At this level the rate of cell detachment from the damaged vascular surface was 88 per cent per h for the first 20 min of flow but gradually decreased to 5 per cent per h after 90 min. These findings suggest that endothelial cells may be retained on damaged vascular surfaces in conditions that approximate to arterial flow.
Pattern of injury in those dying from traumatic amputation caused by bomb blast
Authors: Hull J B , Bowyer G W , Cooper G J , Crane J 
Published: March 2007

Abstract
Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products.
Management of soft tissue sarcoma
Authors: Pitcher M E , Fish S , Thomas J M 
Published: March 2007

Abstract
A total of 485 patients with a proven or suspected diagnosis of soft tissue sarcoma were referred over a 3-year period. Of these, 61 were referred for opinion only and 424 for definitive treatment. Overall there were 223 patients with primary soft tissue sarcoma and 84 with recurrent sarcoma, 84 with benign soft tissue tumours and 22 with non-soft tissue sarcoma malignancy; 11 patients were referred with known metastatic disease. The commonest benign tumours mimicking soft tissue sarcoma were fibromatosis and benign intermuscular or intramuscular lipoma. The malignant tumours suspected clinically of being soft tissue sarcoma were bone tumours, lymphoma and metastatic carcinoma. Of the 172 patients with primary soft tissue sarcoma referred with a proven diagnosis this had been established by excision biopsy in 94 and open incision biopsy in 48. By contrast, of those undiagnosed at referral, 44 of 51 patients with soft tissue sarcoma had the diagnosis made by Tru-cut core biopsy. Amputation was performed in four of 165 patients with primary extremity soft tissue sarcoma and in five of 54 with recurrent extremity sarcoma, giving an overall amputation rate of 4 per cent. It is proposed that the amputation rate for extremity soft tissue sarcoma can be reduced by the use of reconstructive procedures, particularly myocutaneous flaps to the proximal limbs and limb girdles, and free vascularized flaps to sites distal to the midthigh and midarm.
Paraoesophageal hernia repair with and without concomitant fundoplication
Authors: Rakić S , Peško P , Dunjić M S , Gerzić Z 
Published: March 2007

Abstract
There is currently no consensus as to whether an antireflux procedure should accompany surgical repair of paraoesophageal hernia. Forty consecutive patients with paraoesophageal hernia were studied. Surgery routinely included transabdominal hernia reduction, excision of the sac and crural repair. The addition of fundoplication was based on the presence of preoperative endoscopic evidence of oesophagitis. Twenty-three patients without endoscopic oesophagitis had no antireflux procedure whereas 17 with oesophagitis underwent concomitant antireflux surgery. Thirty-six patients were followed for 1–7 years. Patients without endoscopic oesophagitis had no postoperative reflux problems. All patients with oesophagitis who underwent fundoplication were improved or cured of reflux. The selection of patients for antireflux repair can satisfactorily be based on preoperative endoscopic findings.
Laparoscopic splenectomy for idiopathic thrombocytopenic purpura
Authors: Gigot J F , Healy M L , Ferrant A , Michaux J L , Njinou B , Kestens P J 
Published: March 2007

Abstract
Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G γ-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations. Seven patients underwent successful laparoscopic splenectomy, with a mean postoperative stay of 3·6 days. One patient with an accessory spleen detected before operation but not during laparoscopy required conversion to open surgery for control of haemorrhage from the splenic hilum. Another patient had a transient pancreatic fistula. Laparoscopic splenectomy is feasible and safe in patients with idiopathic thrombocytopenic purpura. Long-term results require evaluation as detection of accessory spleens can prove difficult during laparoscopy.