bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypotension induced by haemorrhage impairs lower oesophageal sphincter function
Authors: Caldwell M T P , Marks P , Byrne P J , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
The effect of haemorrhage-induced hypotension on lower oesophageal sphincter (LOS) tone was studied in 11 adult mongrel dogs. Mean(s.e.m.) blood loss of 760(66) ml, corresponding to 42 per cent of estimated blood volume, was associated with a significant fall in LOS tone (14·2(1·0) versus 7·2(0·6) sphinctometer units, P&lt;0·002). This was associated with a reduction in mean(s.e.m.) arterial blood pressure (99(7) versus 53(3) mmHg, P&lt;0·002) and heart rate (113(6) versus 106(5) beats per min, P=0·06). Group 1 animals (n = 6) received autotransfusion, restoring LOS tone to prehaemorrhage values. Dogs in group 2 (n = 5) were given intravenous erythromycin 4 mg/kg, which also restored LOS tone. This effect was transient, lasting a mean(s.e.m.) of only 67(7) min. Infusion of an equivalent volume of 0·9 per cent saline following cessation of the erythromycin effect restored LOS tone to control values although the animals remained hypotensive. Reduction in LOS tone with haemorrhage may be part of a vagal reflex mediated by myocardial afferent C fibres and may explain the high incidence of pulmonary aspiration in shocked patients.
Long-term effects of postoperative total parenteral nutrition supplemented with glycylglutamine on subjective fatigue and muscle protein synthesis
Authors: Petersson B , von der Decken A , Vinnars E , Wernerman J 
Published: March 2007

Abstract
Seventeen patients undergoing elective open chole-cystectomy were given conventional total parenteral nutrition either with (nine patients) or without (eight) glutamine supplementation of 20 g/day for 3 days after surgery and thereafter ordinary food for the following 27 days. Muscle protein synthesis, as assessed by the total concentration of ribosomes, decreased in control patients on day 3 following surgery and remained low on days 10, 20 and 30 (P &lt; 0·05). In patients who received glutamine the total ribosome concentration was maintained on the third day after operation. Concurrently, the subjective feeling of fatigue increased on days 3 and 10 after surgery and the nitrogen balance was negative after operation in both groups, without any difference related to glutamine supplementation. Intravenous glutamine after surgery counteracts a decline in muscle protein synthesis only for as long as it is provided.
Percutaneous cystogastrostomy for chronic pancreatic pseudocyst
Authors: Henriksen F W , Hancke S 
Published: March 2007

Abstract
During the years 1984–1992, 74 patients of mean age 45 (range 6–71) years with chronic pancreatic pseudocyst were treated by percutaneous cystogastrostomy. They comprised 45 men and 29 women. A diagnosis of chronic pancreatitis was verified in 55 patients (74 per cent); pain was the indication for treatment in all cases. The catheter was successfully placed at the first attempt in 68 patients (92 per cent). Immediate complications occurred in four patients (5 per cent); there have been none since 1986. Abscess formation was seen in eight patients (11 per cent). One patient died 4 days after the procedure from myocardial infarction giving a mortality rate of 1 per cent; no death has occurred since 1986. The mean observation time was 27 (range 0–108) months. Pain disappeared or decreased in almost 90 per cent of patients and weight gain was seen in 80 per cent. The method described is less traumatic than operation, and mortality and complication rates compare favourably with those seen after surgery; the results are at least as good.
Iodized oil in the treatment of hepatocellular carcinoma
Authors: Bhattacharya S , Novell J R , Winslet M C , Hobbs K E F 
Published: March 2007

Abstract
When injected into the hepatic artery the contrast agent Lipiodol (iodized poppy seed oil) is selectively retained by hepatocellular carcinoma (HCC) for a prolonged period of time. Liver computed tomography (CT) performed after Lipiodol angiography is more sensitive than ordinary CT at imaging HCC. Arterial administration of cytotoxic drugs and radioisotopes conjugated to Lipiodol has been shown to be reasonably safe in patients with irresectable HCC. These therapies, often combined with embolization, provide effective palliation, better tumour response and improved survival compared with other available treatments. Their use as a preoperative adjunct to surgical resection of HCC is controversial.
Right atrial electrocardiography: A technique for the placement of central venous catheters for chemotherapy or intravenous nutrition
Authors: Madan M , Shah M V , Alexander D J , Taylor C , McMahon M J 
Published: March 2007

Abstract
Central venous catheters used for chemotherapy are usually sited so that the catheter tip lies in the superior vena cava. This study evaluated right atrial electrocardiography as a method of accurately placing the catheter tip in 34 patients over a period of 22 months. An electrocardiograph adaptor was connected to the catheter and the tip advanced into a central vein until a biphasic P wave was identified. In 31 of 34 patients the characteristic P wave changes were observed and the position of the catheter tip confirmed by screening to be in the superior vena cava. Right atrial electrocardiography is an accurate, reliable and rapid method of positioning the tip of a central venous catheter, and avoids or reduces exposure to radiation.
Closure of midline laparotomy incisions with polydioxanone and nylon: The importance of suture technique
Authors: Israelsson L A , Jonsson T 
Published: March 2007

Abstract
The healing of midline laparotomy incisions closed with a continuous suture of nylon or second-generation polydioxanone was evaluated in a randomized clinical trial. The effect of suture technique, reflected in the suture length to wound length ratio, was also assessed. All patients who underwent abdominal surgery through a midline incision were included except those with incisional hernia after previous midline operation. Wound dehiscence occurred in five (0·6 per cent) of 813 patients and wound infection in 73 (9·0 per cent). These rates were similar for both suture materials, as were those for the development of suture sinus and prolonged postoperative wound pain. Incisional hernia 12 months after surgery was found in 49 (15·1 per cent) of 325 wounds sutured with polydioxanone and in 50 (15·7 per cent) of 318 closed with nylon (P=0·91). There was a significant correlation between the hernia rate and the suture to wound length ratio for both materials (P&lt;0·001). These results indicate that suture of midline laparotomy wounds is as safe with polydioxanone as it is with nylon. Incisional hernia is associated more with suture technique than with the material used.
Classification of the sequelae of bowel resection for Crohn's disease
Authors: Cosnes J , De Parades V , Carbonnel F , Beaugerie L , Ngo Y , Gendre J P , Sezeur A , Gallot D , Malafosse M , Le Quintrec Y 
Published: March 2007

Abstract
A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0·64 and 0·90, and 0·60 and 0·99 respectively in the retrospective series; values were 0·80 and 0·71, and 0·25 and 1·00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.
Laparoscopic surgery in patients with human immunodeficiency virus
Authors: Tanner A G , Hartley J E , Darzi A , Rosin R D , Monson J R T 
Published: March 2007

Abstract
Fifteen patients with acquired immune deficiency syndrome (AIDS), and one who tested positive for human immunodeficiency virus but had no AIDS-defining diagnosis, underwent a range of laparoscopic procedures between March 1991 and March 1993. Seven cholecystectomies and one cholecystojejunostomy were performed. Three patients underwent diagnostic laparoscopy after presenting with abdominal emergencies. Two further patients had laparoscopic adhesiolysis and one appendicectomy. A further patient underwent laparoscopically assisted end colostomy and another an inguinal hernia repair, both performed electively. Two patients died in the postoperative period. There was little postoperative morbidity. Six patients died 3–18 months after surgery from progressive AIDS. This early experience suggests that laparoscopic surgery is well tolerated in these patients.
Survival after surgery for cancer of the gallbladder
Authors: Ouchi K , Suzuki M , Tominaga T , Saijo S , Matsuno S 
Published: March 2007

Abstract
The records of 45 patients with carcinoma of the gallbladder who had undergone surgical resection at least 5 years previously were reviewed retrospectively to determine which factors influence long-term survival. Seventeen patients survived at least 5 years and 23 died from recurrence (five patients were excluded from analysis). Of the 17 long-term survivors 15 had tumours superficial to the subserosa that showed a non-infiltrative growth pattern. Those alive at 5 years were more likely than short-term survivors to have tumours that were papillary (P&lt;0·05) or well differentiated (P&lt;0·01) adenocarcinoma. Venous, lymphatic and perineural invasion was more common in short- than in long-term survivors (87 versus 29 per cent, P&lt;0·001). Patients with tumours limited to the muscularis and those with non-infiltrative subserosal involvement are likely to have better survival and may have a chance of cure after extended cholecystectomy.
Virtual reality and laparoscopic surgery
Authors: Coleman J , Nduka C C , Darzi A 
Published: March 2007

Abstract
The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.
Familial adenomatous polyposis
Authors: Campbell W J , Spence R A J , Parks T G 
Published: March 2007

Abstract
Familial adenomatous polyposis (FAP) is an autosomal dominant condition resulting in the development of more than 100 adenomatous polyps in the large bowel. In addition, a number of extracolonic manifestations of the condition may occur. Recently, increasing knowledge relating to the extracolonic abnormalities, and localization and sequencing of the gene for FAP, have had important implications for screening and long-term follow-up of those affected. In this review the natural history of the disease and the extracolonic manifestations associated with it are considered. Surgical management and advances in understanding at a molecular level are discussed, as well as the problems relating to screening for FAP and the implications of the new knowledge.
Proliferating cell nuclear antigen in the assessment of Barrett's mucosa
Authors: Gillen P , McDermott M , Grehan D , Hourihane D O'B , Hennessy T P J 
Published: March 2007

Abstract
Proliferating cell nuclear antigen (PCNA) expression was assessed in oesophageal epithelium from 70 patients with Barrett's oesophagus. PCNA counts were expressed in the form of a PCNA index. There were 24 patients with dysplastic epithelium, nine with regenerative atypia, 18 with benign histology and 19 with adenocarcinoma arising in Barrett's epithelium. The PCNA index of malignant tissue was significantly different from that of benign (P &lt; 0.001) and dysplastic (P &lt; 0.05) specimens. PCNA indices in histologically normal Barrett's epithelium adjacent to a tumour were significantly different (P &lt; 0.001) from those in normal Barrett's epithelium with no adjacent tumour. These findings support the use of PCNA measurement in the assessment of Barrett's epithelium.
Groin dissection in malignant melanoma
Authors: Karakousis C P , Driscoll D L 
Published: March 2007

Abstract
A total of 205 patients who underwent groin dissection for malignant melanoma were reviewed to document complications and survival rates. Wound complications included skin-edge necrosis in 8 per cent, wound infection in 16 per cent, lymphocele in 5 per cent and lymphorrhoea in 11 per cent. Lymphoedema of the operated leg below the knee was noted in 40 per cent, but all patients had localized oedema of the anteromedial thigh. The 5-year overall and disease-free survival rates were 43 and 35 per cent respectively when only the inguinal nodes were involved; they were 34 and 21 per cent with involvement of both the inguinal and deep nodes. The 10-year survival rate for these two groups was 39 and 25 per cent respectively, which suggests that a thorough, complete dissection of the deep nodes is worth-while when the inguinal nodes are palpably positive.
Wheat fibre, lactulose and rectal mucosal proliferation in individuals with a family history of colorectal cancer
Authors: Rooney P S , Hunt L M , Clarke P A , Gifford K -A , Hardcastle J D , Armitage N C 
Published: March 2007

Abstract
In a single-blind study 38 individuals at increased risk of developing colorectal cancer because of a family history of the disease were randomized to take 10.5 g wheat fibre (Trifyba) or 60 ml lactulose daily for 12 weeks. Rectal biopsies were taken before and after treatment and rectal mucosal proliferation was measured by the crypt cell production rate (CCPR). The mean(s.d.) CCPR was significantly lower in those taking wheat fibre after 12 weeks (7.2(3.4) crypt cells per crypt per h) compared both with values obtained before treatment with wheat fibre (10.2(5.1) crypt cells per crypt per h; P=0.02) and after treatment with lactulose (9.4(3.8) crypt cells per crypt per h; P=0.05). Proliferation in the lactulose group was not significantly different at 12 weeks compared with the value obtained before treatment. This study confirms an anti-proliferative effect of wheat fibre in a group of high-risk individuals.
Inflammatory mediators in acute pancreatitis
Authors: Formela L J , Galloway S W , Kingsnorth A N 
Published: March 2007

Abstract
The cellular events leading to acute pancreatitis are not well defined and the mechanism by which known aetiological factors initiate the disease process remains to be established. Inflammatory mediators have recently been implicated as potential early markers of disease severity and may help elucidate the pathophysiology of the disease. Oxidative stress is emerging as a common effector of the acinar cell injury in experimental acute pancreatitis and clinical findings indicate that neutrophil activation is a significant early event. In common with neutrophil-mediated tissue damage in states of tissue hypoperfusion, acute pancreatitis shows many features of an ischaemia-reperfusion injury. Increased levels of phospholipase A2 have been demonstrated; this enzyme induces synthesis of prostaglandins and platelet-activating factor, a potent inflammatory mediator. New therapeutic approaches to the complications of acute pancreatitis may be through manipulation of such mediators of inflammation.
Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: Indications and results
Authors: Mouroux J , Riquet M , Padovani B , Debesse B , Richelme H 
Published: March 2007

Abstract
The records of 97 patients with thoracic complications of human immunodeficiency virus (HIV) were analysed to determine the reasons for surgery and the results of these procedures. Of the patients, 79 underwent surgery; the remaining 18 were managed non-surgically. A total of 36 procedures were performed for diagnostic purposes: mediastinoscopy (21 patients), lung biopsy (15 patients). Therapeutic procedures were performed in 61 patients to treat pneumothorax (23 cases) or empyema thoracis (18 cases), for resection of pulmonary lesions (13 cases), and to treat various other pathologies (seven cases). Ten patients died in hospital: seven after surgery and three after a non-surgical procedure. Eleven patients developed a postoperative complication. Hospital mortality varied from 0 per cent to 20 per cent, depending on the procedure. The mortality rate appears to be linked to the stage of HIV infection at the time of therapy rather than to the type of procedure performed. Surgical decisions must take into account the patient's Centers for Disease Control stage and physiological status, therapeutic possibilities, and the prognosis of the pathology requiring treatment.
Predictive value of colour Doppler ultrasonography in detecting failure of vascular access grafts
Authors: Köksoy C , Kuzu A , Erden Ǐ , Türkçapar A G , Düzgün Ǐ , Anadol E 
Published: March 2007

Abstract
The predictive role of colour Doppler ultrasonography in determining the initial success and long-term patency of polytetrafluoroethylene (PTFE) vascular access grafts for haemodialysis was investigated. Two groups of patients were studied. The upper extremities of 21 patients in the control group were assessed by clinical examination only; those of 17 in a second group (Doppler group) were also assessed by ultrasonography before and after operation. Straight PTFE vascular access grafts were used between the brachial artery and axillary vein in all patients. The median preoperative brachial artery flow rate was significantly lower in patients who later developed graft thrombosis (66 versus 87 ml/min, P &lt;0·01), as was the median postoperative graft flow rate (480 versus 800 ml/min, P &lt;0·001). Routine preoperative and postoperative colour Doppler ultrasonography is recommended for every patient in whom a vascular access graft is planned.
Diagnostic difficulties in patients with a ruptured bladder
Authors: Mokoena T , Naidu A G 
Published: March 2007

Abstract
Isolated bladder rupture has an insidious presentation which results in delayed diagnosis and management. Forty-four patients, of mean age 33·3 years, were seen over a period of 7 years. There was a history of trauma in 33 patients, although this was minor in 20. Alcohol intoxication, head injury or paraplegia could have led to lack of sensation of the distending and subsequently injured bladder in 18 patients. The mean delay between an identifiable incident or presentation and diagnosis was 5·4 days. The mean admission or preoperative levels of blood urea and creatinine were raised to 19·6 mmol/1 and 362 μmol/1 respectively in those with a delayed diagnosis. The diagnosis was made by voiding cystourethrography in 36 patients and by laparotomy in eight. When blood urea and creatinine concentrations are increased in a patient with an ill-defined abdominal ailment and a history of trauma or drunkenness, ruptured bladder should be considered.
Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer
Authors: Forouhi P , Dixon J M , Leonard R C F , Chetty U 
Published: March 2007

Abstract
The influence of primary systemic therapy in treating operable breast cancer on postmastectomy morbidity rates was investigated. The contribution of other risk factors was assessed by multiple logistic regression. Seventy-nine eligible patients were randomly allocated, 39 to undergo immediate modified radical mastectomy, and 40 to receive initial cytotoxic or endocrine treatment followed by mastectomy. Postoperative wound seroma, infection and necrosis were recorded prospectively. Fourteen minor and six major complications occurred in 17 patients treated conventionally, while 14 patients developed 11 minor and six major complications after systemic therapy (P &gt;0·4). Median hospital stay was 8 days for both groups. Age, smoking, immediate breast reconstruction and the type of primary systemic treatment given were not independent predictors of complication risk. Obesity emerged as a significant risk factor for postmastectomy complications (P = 0·015). Primary systemic therapy does not increase the rate of morbidity after mastectomy.
Modulation of the cytokine and acute-phase response to major surgery by recombinant interleukin-2
Authors: Deehan D J , Heys S D , Simpson W , Broom J , McMillan D N , Eremin O 
Published: March 2007

Abstract
Major surgery suppresses host immune reactivity through alterations in monocyte and T cell-derived cytokine, eicosanoid and acute-phase protein release. Recombinant interleukin (IL) 2 augments T lymphocyte and monocyte activity in vitro. Eighteen patients, with localized colorectal cancer, were randomized to receive either recombinant IL-2 or placebo for 3 days by subcutaneous injection before surgery. Serum levels of IL-1β, IL-6, tumour necrosis factor α, soluble IL-2 receptor, C-reactive protein (CRP) and albumin were measured, and T lymphocyte surface expression of HLA-DR and CD25 and neutrophil phagocytosis were determined, before and for 21 days after surgery. Significant augmentation of IL-6, CRP and soluble IL-2 receptor production, enhanced expression of activation markers and increased neutrophil activity were found. Recombinant IL-2 may have a role in ameliorating immunosuppression found after major surgery.
Gastric motility following oesophagectomy
Authors: Walsh T N , Caldwell M T P , Fallon C , McGeown G , Kidney D , Freyne P , Byrne P J , Hennessy T P J 
Published: March 2007

Abstract
The motility of the vagally denervated transposed stomach after oesophagectomy was examined by ambulatory gastric manometry and videofluoroscopy. Two groups of subjects were studied. Group 1 comprised ten patients who had undergone oesophagectomy 6–12 months previously and group 2 consisted of six normal control subjects. Studies were performed on fasting and fed subjects, and following injection of erythromycin 8 mg/kg. No distinguishable manometric wave activity was seen in either group while fasting. Feeding generated a measurable wave pattern in the patient group only. A significant increase in the mean(s.e.m.) distal wave amplitude was identified after infusion of erythromycin in both patients (34·0(15·1) versus 12·2(3·1) mmHg, P &lt; 0·05) and controls (15·1(3·4) versus 5·0(0·0) mmHg, P = 0·05). The response to erythromycin was more rapid in patients than in controls (mean(s.e.m.) 113(16) versus 377(133) s, P &lt;0·05) and the effect persisted for longer (more than 1 h) in those who had undergone oesophagectomy. Videofluoroscopy confirmed purposeful motility in both the normal and vagally denervated stomach. It is concluded that the transposed stomach is a dynamic conduit. Enhancement of motility was greatest in the denervated stomach, indicative of denervation supersensitivity.