bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of thymopentin on the incidence and severity of postoperative infection: A randomized controlled trial
Authors: Braga M , Costantini E , Di Francesco A , Gianotti L , Baccari P , Di Carlo V 
Published: March 2007

Abstract
The effectiveness of perioperative administration of thymopentin in preventing postoperative infection was evaluated in 206 patients with cancer (54 gastric, 152 colorectal) who underwent elective major surgery. Comparable subsets of patients were obtained with respect to age (proportion over 65 years) and nutritional status (patients with serum albumin level less than 30 g/l or weight loss of 10 per cent or more of usual body-weight were considered to be malnourished). Patients were then randomly assigned to a control group or to a group receiving thymopentin. All patients received perioperative short-term antibiotic prophylaxis and postoperative parenteral nutrition. Levels of CD3-, CD4- and CD8-positive T cell subsets were evaluated before and after surgery in 20 (ten elderly) patients from each group. The severity of postoperative infection was evaluated using a sepsis score. In elderly patients thymopentin prevented the postoperative drop in CD3- and CD4-positive T cell subpopulations that was observed in controls (P &lt; 0·05). The postoperative infection rate was 17·5 per cent in the group given thymopentin and 24·3 per cent in controls (P not significant). The mean(s.d.) sepsis score was 6·7(3·1) in the group receiving thymopentin and 9·4(5·8) in controls (P not significant). Considering only elderly patients, the mean(s.d.) sepsis score was significantly lower in those treated with thymopentin than in control patients (6·9(2·1) versus 11·3(4·7)). In conclusion, administration of thymopentin did not significantly reduce the postoperative infection rate. However, it prevented the drop in number of CD3- and CD4-positive T cells after operation and reduced the severity of postoperative infection in elderly patients.
Tumour necrosis factor-mediated release of plasminogen activator inhibitor 1 by human peritoneal mesothelial cells
Authors: Whawell S A , Scott-Coombes D M , Vipond M N , Tebbutt S J , Thompson J N 
Published: March 2007

Abstract
Human mesothelial cells synthesize plasminogen activator inhibitor (PAI) 1 in inflamed peritoneal tissue. The role of tumour necrosis factor (TNF) in the mediation of this response was studied. Postoperative peritoneal drain fluid contained both TNF and PAI-1. Peak levels of TNF at 4 h (median 271 pg/ml) preceded a rise in PAI-1 concentration, which peaked at 18 h (median 943·1 ng/ml). Thus TNF may mediate increased PAI-1 release in inflamed peritoneum. TNF significantly increased the mean(s.e.m.) release of PAI-1 by human peritoneal mesothelial cells in vitro at 4 h (control 1·84(0·17) ng/μg versus TNF 2·37(0·17) ng/μg, P0·05), 6 h (2·53(0·09) versus 3·88(0·46) ng/μg, P&lt;0·05), 18 h (0·50(0·02) versus 1·04(0·11) ng/μg, P&lt;0·05) and 24 h (0·87(0·05) versus 1·35(0·11)ng/μg, P&lt;0·05). TNF may be an important mediator of PAI-1 production by human mesothelial cells during peritoneal inflammation.
Recurrent laryngeal nerve palsy after thyroid gland surgery
Authors: Wagner H E , Seiler Ch 
Published: March 2007

Abstract
Risk factors for recurrent laryngeal nerve (RLN) lesions after thyroid gland surgery were evaluated retrospectively in 1026 patients. RLN palsy occurred in 5·9 per cent; the incidence of permanent palsy was 2·4 per cent as 59 per cent of paralyses were transient. For euthyroid nodular goitre, Graves' disease, chronic lymphocytic thryoiditis, recurrent goitre and thyroid carcinoma, permanent nerve damage occurred in 1·7, 4, 5, 3·8 and 8 per cent of patients respectively. In relation to the number of nerves at risk, the incidence of permanent RLN palsy was 1·1 per cent for subtotal lobectomy and 4·0 per cent for total lobectomy. The overall incidence of permanent RLN palsy was 1·8 per cent of nerves at risk. There was no statistically significant difference between the number of RLN paralyses occurring after nerve exposure and that occurring after non-exposure in subtotal lobectomy, but in total lobectomy the permanent palsy rate increased from 3·8 to 7 per cent when the nerve was not exposed or identified (P&lt;0·01). Underlying thyroid disease, the extent of resection and exposure of the nerve in total lobectomy are risk factors for both transient and permanent RLN palsy.
Right thoracoscopically assisted oesophagectomy for cancer
Authors: McAnena O J , Rogers J , Williams N S 
Published: March 2007

Abstract
Thoracoscopic mobilization was performed in nine patients with oesophageal cancer. Five principles emerged as essential for successful dissection: (1) the selection of patients with mobile oesophageal tumours without evidence of local invasion; (2) double-lumen anaesthesia and complete collapse of the right lung during surgery; (3) simultaneous use of a flexible gastroscope; (4) high-quality illumination; and (5) minimal blood loss during dissection. The surgeon should have adequate training in thoracic operations. Further experience should permit mediastinal lymph node dissection. Postoperative pulmonary complications were common, requiring prolonged intensive care management. Widespread adoption of the technique cannot be recommended.
Distal splenorenal shunting for bleeding gastric varices
Authors: Thomas P G , D'Cruz A J 
Published: March 2007

Abstract
In patients with bleeding gastric varices from causes other than splenic vein thrombosis, endoscopic sclerotherapy and ablative surgery have yielded poor results. Over a 3-year period starting in June 1989, a total of 30 distal splenorenal shunts were performed prospecdvely on 19 paediatric and 11 adult patients with bleeding gastric varices and good liver function. The mean(s.d.) age was 17(12) (range 6–50) years; there were 20 male and ten female patients of whom six had cirrhosis, four non-cirrhotic portal fibrosis and 20 portal vein thrombosis. Two patients died and two more had shunt thrombosis; all four were considered failures of treatment. Hypersplenism was present in 15 patients but reverted to normal in 13. In 26 patients the gastric varices disappeared. Concomitant oesophageal varices were present in 22 patients and showed marked regression, with no rebleeding over a mean(s.d.) follow-up of 21(10) (range 7–39) months. A distal splenorenal shunt was effective in controlling gastric variceal haemorrhage in 26 of 30 patients in whom liver function was well preserved.
Compartment syndrome in experimental chronic obstructive pancreatitis: Effect of decompressing the main pancreatic duct
Authors: Karanjia N D , Widdison A L , Leung F , Alvarez C , Lutrin F J , Reber H A 
Published: March 2007

Abstract
Chronic pancreatitis is characterized by persistent and severe pain, which can be relieved by decompression of the main pancreatic duct (MPD). Both ductal and interstitial pressures have been shown to be increased in chronic pancreatitis in patients. A study was carried out of pancreatic interstitial pressure and pancreatic blood flow in normal cats and those in which chronic obstructive pancreatitis had been induced 5 weeks earlier to determine the effect of decompression of the MPD. In the normal pancreas, median (interquartile range (i.q.r.)) basal interstitial pressure was 0·05(1·2) mmHg and median (i.q.r.) basal pancreatic blood flow 58·3(24·3) ml per min per 100 g. Secretory stimulation did not change the interstitial pressure significantly, but was associated with a 40 per cent increase in median(i.q.r.) blood flow to 81·8(45·8) ml per min per 100 g. In contrast, in chronic obstructive pancreatitis, the median(i.q.r.) basal inteistitial pressure was 2·0(1·5) mmHg, which was significantly higher than in the normal gland, and median(i.q.r.) pancreatic blood flow was 38·3(9·8) ml per min per 100 g, significantly lower than in the normal pancreas. Furthermore, secretory stimulation was associated with a significant increase in median(i.q.r.) interstitial pressure to 3·3(1·6) mmHg and a simultaneous decrease in median(i.q.r.) blood flow to 31·5(13·7) ml per min per 100 g. After decompression of the MPD in cats with chronic obstructive pancreatitis, the median(i.q.r.) basal interstitial pressure was 2·0(1·4) mmHg and on secretory stimulation 1·8(1·5) mmHg. Decompression thus prevented the increase in interstitial pressure seen in the animals with obstruction. In contrast, ductal decompression improved the median(i.q.r.) basal pancreatic blood flow to 45·9(38·4) ml per min per 100 g and, furthermore, this increased significantly on secretory stimulation to a median(i.q.r.) of 81·4(47·8) ml per min per 100 g. Decompression thus restored the normal pattern of secretory hyperaemia. Within the confines of this model, these observations demonstrate that chronic obstructive pancreatitis exhibits a compartment syndrome that is relieved by duct drainage.
Motor determinants of incontinence after ileal pouch–anal anastomosis
Authors: Ferrara A , Pemberton J H , Grotz R L , Hanson R B 
Published: March 2007

Abstract
Anal canal pressure gradient and ileal pouch motor activity were studied in continent and incontinent patients after ileal pouch-anal anastomosis. A multichannel microtransducer catheter was positioned in eight continent and eight incontinent patients 15 months or more after operation and 24-h ambulatory motor activity recorded. Resting anal pressures were significantly lower for incontinent patients during the day and night. The frequency of high-pressure waves was identical in both groups, but peak pressures were higher for incontinent patients. For continent patients, each high-pressure wave was accompanied by a rapid increase in anal canal pressure such that pressure in the pouch was always less than that in the anal canal. For incontinent patients this response was often absent. Incontinent patients had lower resting pressure, more prolonged anal canal relaxation, higher amplitude high-pressure waves and a non-responsive anal canal; the anal canal pressure gradient was therefore frequently reversed.
Lateral lymph node dissection for rectal carcinoma below the peritoneal reflection
Authors: Moreira L F , Hizuta A , Iwagaki H , Tanaka N , Orita K 
Published: March 2007

Abstract
Lateral lymph node dissection has been advocated for advanced low rectal tumours. However, its benefit is debatable because of the possibility of postoperative bladder and sexual impairment. To assess the role of lateral lymph node dissection 95 patients who underwent the procedure between 1981 and 1991 were reviewed and compared with 83 who had resection of rectal cancer without lateral node dissection. Only ten (11 per cent) of the 95 patients had lateral lymph node involvement; all had Dukes'C tumours. Lymphovascular invasion was present in 50·6 per cent of all patients and neural invasion in 27 per cent of 65 examined specimens. Local recurrence, distant metastasis and overall 5-year survival rates were 7, 9 and 76 per cent respectively in patients undergoing extended lymphadenectomy and 16, 7 and 72 per cent respectively in those who had resection alone. There were no statistically significant differences in survival between the two groups for any Dukes' stage. Recurrence, metastasis and survival were related more to venous or neural invasion and tumour spread than to node dissection. These results demonstrate that patients with Dukes' A tumours do not benefit from latera lymph node dissection, and that local recurrence rates in those with Dukes' B and C lesions are not significantly decreased. It is concluded that extended lymphadenectomy is unlikely to provide significant benefit to patients with low rectal cancer.
Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse
Authors: Deen K I , Grant E , Billingham C , Keighley M R B 
Published: March 2007

Abstract
A randomized trial was performed to compare abdominal resection rectopexy and pelvic floor repair (n = 10) with perineal rectosigmoidectomy and pelvic floor repair (n = 10) in elderly female patients with full-thickness rectal prolapse and faecal incontinence. There were no recurrences of full-thickness prolapse following resection rectopexy but one after rectosigmoidectomy. Continence to liquid and solid stool was achieved in nine patients, with faecal soiling reported in only two, after resection rectopexy and in eight, with soiling in six, following rectosigmoidectomy. The median (range) frequency of defaecation was only 1 (1–3) per day following resection rectopexy compared with 3 (1–6) per day after rectosigmoidectomy. There was an increase in the mean(s.d.) maximum resting pressure after resection rectopexy (19·3(15·28) cmH2O) compared with a reduction following rectosigmoidectomy (– 3·4(13·75) cmH2O) (P = 0·003). Mean(s.d.) compliance was also greater after resection rectopexy than following rectosigmoidectomy (3·9(0·75) versus 2·2(0·78) ml/cmH2O, P&lt;0·001). Abdominal resection rectopexy gives better functional and physiological results than perineal rectosigmoidectomy.
Peritonitis impairs intestinal absorption of proline and leucine in the rat
Authors: Gardiner K R , Gardiner R E , Barbul A 
Published: March 2007

Abstract
Systemic sepsis is associated with reduced mesenteric blood flow and impairment of metabolic and barrier functions of the small intestine. A study was performed in the rat to investigate the effect of sepsis induced by caecal ligation and double puncture on intestinal absorption of leucine and proline in vivo. Absorption was studied 24 h after caecal ligation and puncture by measuring intestinal disappearance and circulatory appearance of intraluminal 3H-labelled amino acid over a 60-min study period.
Peritonitis resulted in a significant increase relative to controls in the mean(s.e.m.) percentage of leucine (67.2(3.6) versus 18.0(3.5), P&lt;0.001) and proline (64.7(6.0) versus 15.1(3.7), P&lt;0.001) remaining within the small intestine. There were significant decreases in portal venous and femoral arterial concentrations of leucine and proline in animals with sepsis. Intestinal amino acid absorption is impaired in this model.
Surgical assessment of acute anorectal sepsis is a better predictor of fistula than microbiological analysis
Authors: Lunniss P J , Phillips R K S 
Published: March 2007

Abstract
Twenty-two patients with acute anorectal sepsis were examined prospectively to compare surgical assessment with microbiological analysis as predictors of the aetiology of the sepsis. Culture of gut organisms was a sensitive method of detecting an underlying fistula but was not particularly specific (80 per cent). Demonstration of sepsis in the intersphincteric space in association with an anorectal abscess was 100 per cent sensitive and 100 per cent specific for detection of an underlying fistula. The demonstration was facilitated by a radially placed incision.
Provision of vascular surgical services in the Oxford Region
Authors: Michaels J A , Browse D J , McWhinnie D L , Galland R B , Morris P J 
Published: March 2007

Abstract
Vascular surgical practice across an entire health region was studied. There was a mean of 115.9 inpatient episodes and 46.9 vascular reconstructions per 100000 population, with considerable variation between districts. Vein utilization for infrainguinal grafts was greater in the teaching hospital and few femorodistal grafts or carotid endarterectomies were carried out elsewhere; there were few tertiary referrals of elective vascular cases. Only two districts have formal arrangements for emergency vascular ‘on-call’. There is marked inequality of provision of vascular surgical services across the region.
Incidence and management of catheter-related sepsis in patients receiving home parenteral nutrition
Authors: Williams N , Carlson G L , Scott N A , Irving M H 
Published: March 2007

Abstract
Fifty patients, comprising 24 male and 26 female of median age 43 (range 15–67) years, received a total of 2620 patient-months of home parenteral nutrition (median 48 (range 2–130) months). There were 13 episodes of bacterial catheter sepsis (of which the catheter was successfully salvaged by an antibiotic-fibrinolytic ‘lock’ technique in four cases) and ten of exit-site sepsis (all managed by elective catheter replacement), representing an incidence of 1 septic complication per 113 patient-months of parenteral nutrition. This low incidence of catheter-related sepsis was achieved by strict adherence to established protocols of catheter management.
Oesophageal perforation: Primary suture repair reinforced with absorbable mesh and fibrin glue
Authors: Bardaxoglou E , Campion J P , Landen S , Manganas D , Siriser F , Chareton B , Launois B 
Published: March 2007

Abstract
Despite major advances in the management of intrathoracic oesophageal perforation, morbidity and mortality rates remain high1,2. Currently accepted management3 includes early thoracotomy, cleansing of the mediastinum, oesophageal suture and pleural space drainage. Even when performed at an early stage, primary oesophageal suture repair remains precarious, however. Experience of oesophageal primary suture reinforced with absorbable mesh and fibrin glue is reported.
Laparoscopic Nissen fundoplication: Technique and preliminary results
Authors: Cadière G B , Houben J J , Bruyns J , Himpens J , Panzer J M , Gelin M 
Published: March 2007

Abstract
Between May 1991 and November 1992, 80 consecutive patients with gastro-oesophageal reflux disease underwent laparoscopic Nissen fundoplication. The technique used was exactly the same as for the conventional open approach. There were no deaths but there were four peroperative complications: one gastric perforation, two pleural perforations and one hepatic laceration. Three conversions to laparotomy were necessary, one because of a defective needle holder and two as a result of left hepatic lobe hypertrophy. The duration of operation ranged from 40 to 300 (median 150) min. The median postoperative stay was 3 days, but increased to 10 days in two patients who developed pulmonary infection. One major postoperative complication (necrosis of the wrap) required a laparotomy on day 8 after operation. No recurrence of heartburn has been observed and there were no instances of long-term dysphagia after surgery. These findings indicate that laparoscopic Nissen fundoplication can be performed safely if the team is well trained.
Prognostic significance of the number of positive lymph nodes in gastric carcinoma
Authors: Adachi Y , Kamakura T , Mori M , Baba H , Maehara Y , Sugimachi K 
Published: March 2007

Abstract
A total of 195 patients with node-positive gastric carcinoma who were treated by curative gastrectomy and lymphadenectomy were studied to evaluate the prognostic significance of the number of metastatic lymph nodes. Univariate analysis showed that the number and level of positive nodes, tumour size and depth of invasion, and type of gastrectomy were significantly related to patient survival. Multivariate analysis indicated that the number of positive nodes (up to six versus seven or more; relative risk 2.91), depth of invasion (three levels; relative risk 1.83) and histological type (well versus poorly differentiated; relative risk 0.63) were independently correlated with survival. The results indicate that the total number of positive nodes is the most significant prognostic factor in patients with node-positive gastric carcinoma.
Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980–1985
Authors: McCulloch P 
Published: March 2007

Abstract
An audit of treatment of gastric carcinoma was conducted in a major general hospital unit in the UK over a 5-year period. In all, 206 patients (114 men, 92 women) with a mean age of 68 years were treated. Operation was performed in 150 patients; 87 underwent gastrectomy with 31 procedures appearing potentially curative. Most tumours were advanced at diagnosis: 92 were stage IV and 34 stage IIIB, with 42 tumours at earlier stages. After the 87 gastrectomies anastomotic leakage occurred in 16 patients (18 per cent) and there were 14 deaths (16 per cent). The rates of resectability, inadequate resection, anastomotic leakage and postoperative mortality varied considerably between surgeons. The 5-year survival rate was 5 per cent overall, 11 per cent after gastrectomy and 32 per cent following curative resection. The results of treatment of gastric cancer by general surgeons are poor and show marked variation between operators. The declining incidence of the disease makes prospective audit difficult. Treatment by fewer surgeons specializing in this area might improve the outcome.
Abdominal ultrasonography for the diagnosis of strangulation in small bowel obstruction
Authors: Ogata M , Imai S , Hosotani R , Aoyama H , Hayashi M , Ishikawa T 
Published: March 2007

Abstract
The efficacy of abdominal ultrasonography for the recognition of strangulation was evaluated prospectively in 231 patients with adhesive small bowel obstruction. The diagnosis based on ultrasonographic criteria was accurate in 35 of 39 patients with strangulation and in 176 of 192 with simple obstruction. Abdominal ultrasonography revealed the presence of strangulation in 13 of 15 patients with strangulation who were clinically diagnosed as having simple obstruction, and ruled it out in 28 of 36 with simple obstruction who were clinically suspected to have strangulation. An akinetic dilated loop observed on real-time ultrasonography proved to have high sensitivity (90 per cent) and specificity (93 per cent) for the recognition of strangulation; however, its positive predictive value for strangulation was only 73 per cent. The presence of peritoneal fluid was sensitive for strangulation. Compared with clinical judgement based on conventional parameters, abdominal ultrasonography proved to be useful for the early recognition of strangulation.
Cystic dilatation of the common bile duct: Surgical treatment and long-term results
Authors: Benhidjeb T , Münster B , Ridwelski K , Rudolph B , Mau H , Lippert H 
Published: March 2007

Abstract
Twelve patients (11 female) with an extrahepatic biliary cyst (six type I, three type II and three type III according to the classification of Todani) are reviewed with emphasis on aetiology, clinical features and long-term results at follow-up of 3–10 years. The clinical manifestations were abdominal pain, cholestasis with jaundice, fever and episodes of pancreatitis. The diagnosis was established before surgery in all cases by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. An abnormally long common channel was found in four patients. Three patients had had cysts drained internally in the 1970s. Of these three patients, one developed carcinoma of the cyst 23 years later. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepaticojejunostomy was performed in nine cases. Two patients, each with a small choledochocele, were treated successfully by endoscopic sphincterotomy and stone extraction. There were no serious postoperative complications. All nine patients operated on remained in good health for 3–10 years. These results support radical excision of the cystically dilated bile duct with reconstruction by end-to-side Roux-en-Y hepaticojejunostomy for types I and II cyst. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesions.