bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal dysfunction in obstructive jaundice
Authors: Fogarty B J , Parks R W , Rowlands B J , Diamond T 
Published: March 2007

Abstract
The association between renal dysfunction and obstructive jaundice is well established. Despite a substantial number of clinical reviews and prospective studies, the exact incidence and extent of the problem has not been determined accurately. Various pathogenic mechanisms and therapeutic strategies have been proposed but renal dysfunction remains a persistent problem in hepatobiliary practice. The intention of this review is to determine the current extent of the problem, outline the proposed pathophysiological mechanisms and assess the current therapeutic options.
Local excision and mucosal advancement for anorectal ulceration in patients infected with human immunodeficiency virus
Authors: Consten E C J , Slors J F M , Danner S A , Offerhaus G J A , Bartelsman J F W M , Van Lanschot J J B 
Published: March 2007

Abstract
In patients infected with human immunodeficiency virus (HIV) no effective surgical procedure has been described for anorectal ulceration that is resistant to medical thearpy. This study was designed to determine the effectiveness of surgical excision of anorectal ulcers, with or without mucosal advancement. The medical records of patients with HIV and anorectal pathology diagnosed between 1984 and 1994 were reviewed. Patients with anorectal ulcers were divided into group A which was treated only with excision and group B in which excision was combined with mucosal advancement. Surgical treatment was considered successful if relief of symptoms was achieved within 4 weeks of the operation. Excision of anorectal ulcers was successful in seven of 16 patients (44 per cent) in group A. Relief of symptoms was achieved in 12 of 13 patients (92 per cent) in group B when surgical excision was combined with mucosal advancement, which is significantly better than the results in group A (P = 0.02). This non-randomized study indicates that after unsuccessful medical treatment persistent symptomatic ulcers should be treated operatively by excision with mucosal advancement.
Bilateral gluteus maximus transposition for anal incontinence
Authors: Christiansen J , Hansen C Rønholt , Rasmussen O 
Published: March 2007

Abstract
Seven patients (five women and two men) with anal incontinence in whom previous surgery had failed, were treated by bilateral gluteus maximus transposition. All patients were incontinent to solid stool. Previous surgery was postanal repair in four women and secondary overlapping suture for obstetric tear in one. The two men were treated in childhood for anal atresia. No covering stoma was used. Wound infection occurred in three patients, requiring surgical drainage in two. After follow-up of more than 1 year three patients experienced improved continence but in four continence was unchanged. Anorectal physiology studies showed moderately increased resting and squeeze pressures in patients who were improved by the operation, but none could retain more than 200 ml of viscous fluid instilled into the rectum. No change in rectal sensitivity or volume tolerance was found. This preliminary series does not indicate that better results are obtained by gluteus maximus transposition than by unstimulated graciloplasty.
Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992
Authors: Berridge D C , Chamberlain J , Guy A J , Lambert D 
Published: March 2007

Abstract
Over a 5-year period a prospective audit was carried out on 1131 patients undergoing surgery for abdominal aortic aneurysm (AAA) in the northern region. A total of 470 operations was performed in teaching hospitals and 661 in district hospitals; emergency operations accounted for 41-5 per cent. The overall mortality rate was 25.8 per cent; for emergency cases this value was 50.0 per cent. Mortality rates for elective surgery were 3.9 per cent in teaching and 12.0 per cent in district hospitals. Patients with ruptured AAA admitted via the accident and emergency department had a higher mortality rate (64.3 per cent) than those admitted by their general practitioner (49.5 per cent) or those referred from the urology department (18.8 per cent). In all, 73 (6.5 per cent) patients were admitted with an alternative diagnosis, ranging from collapse of unknown cause (25) to torsion of the testes (one) and colonic obstruction (one). Age had a profound effect on mortality rates. For emergency cases the mortality rate varied from 47.0 per cent (in teaching plus district hospitals) in those aged less than 80 years to 70.1 per cent in those 80 years or over (χ2 = 7.22; P = 0.007). For elective surgery the mortality rate varied from 7.6 per cent (in teaching plus district hospitals) in those under 80 years to 23.8 per cent in those 80 years or over (P = 0.0006). The overall mortality rate of 25.8 per cent is significantly less than that quoted in the Confidential Enquiry into Perioperative Deaths report of 1987. Furthermore, elective patients over 80 years of age may expect a survival rate of 76 per cent and, in the absence of major medical contraindications, should not automatically be denied surgery. Importantly, it is of note that this prospective audit identified 31 per cent more cases than recognized by regional audit data.
Anterior gastric wall stapling combined with posterior truncal vagotomy in the treatment of duodenal ulcer
Authors: Van Hee R , Mistiaen W , Hendrickx L , Blockx P 
Published: March 2007

Abstract
Anterior gastric stapling with posterior truncal vagotomy was examined as an alternative to highly selective vagotomy in the treatment of peptic ulcer disease. A clinical series of 32 patients who underwent the combined procedure is presented; gastric acid output was adequately reduced (basal output by 82 per cent, peak by 64 per cent). Motility changes were temporary and mild. Clinical follow-up, using a modified Visick grading, showed good to excellent results in 21 of 25 patients who could be classified. This procedure is suggested as an appropriate alternative to highly selective vagotomy.
Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy
Authors: Anvari M , Allen C , Borm A 
Published: March 2007

Abstract
A total of 168 patients with proven gastro-oesophageal reflux disease (GORD) receiving long-term medical therapy underwent laparoscopic Nissen fundoplication. The operation was converted to open fundoplication in four patients. All patients reported complete (92.3 per cent) or partial (7.7 per cent) relief of reflux symptoms 1 month after surgery. There were no associated deaths and the perioperative complication rate was 8.9 per cent. The mean(s.e.m.) length of operating time was 69.9(2.4) min and mean(s.e.m.) hospital stay 2.7(0.1) days. Symptom score assessment, 24-h oesophageal pH recording and lower oesophageal sphincter pressure showed significant (P &lt; 0.0001) improvement 6 months after surgery in 85 evaluable patients. Before operation 37.5 per cent of the patients were considered symptomatically controlled on omeprazole and had excellent symptom control after surgery. This initial experience suggests that laparoscopic Nissen fundoplication is a safe and effective treatment for patients with GORD requiring long-term medication.
Small bowel obstruction caused by a retained percutaneous endoscopic gastrostomy gastric flange
Authors: Lambertz M M , Earnshaw P M , Short J , Cumming J G R 
Published: March 2007

Abstract
In 1980 Gauderer et al.1 described a pull-through technique to position a percutaneous endoscopic gastrostomy (PEG) tube. Recognized complications are pulmonary aspiration, peritonitis and haemorrhage. Longer term problems include peristomal wound infection, gastrocolic fistula and frequent tube blockage. The reported overall mortality rate is less than 1 per cent2,3.
Correlation between expression of sialosyl-T antigen and survival in patients with gastric cancer
Authors: Tsuchiya A , Kikuchi Y , Ando Y , Abe R 
Published: March 2007

Abstract
Intestinal metaplasia of the gastric mucosa is an important lesion in the pathogenesis of gastric cancer. The expression of a mucin-associated antigen, sialosyl-T antigen, in the tissue of gastric cancer was investigated immunohistochemically to assess its biological role. Sialosyl-T antigen, detected by the monoclonal antibody TKH2, was present in 30 (23.6 per cent) of 127 lesions, and expressed sporadically in intestinal metaplasia. Patients negative for sialosyl-T had a significantly better 5-year survival than those who were positive (70.4 per cent versus 47.2 per cent). Grading by sialosyl-T antigen expression and the DNA ploidy pattern had a predictive value for prognosis in patients with gastric cancer. The biological role of sialosyl-T antigen is not clear but the mucin alteration reflects upon the biological behaviour of gastric cancer.
Tumour S-phase activity, nucleotide profile and RNA levels after hepatic artery occlusion and reperfusion in an experimental model of secondary liver carcinoma
Authors: Wang L Q , Roos G , Andersson B , Renfjärd E , Persson B , Stenram U 
Published: March 2007

Abstract
Rats with carcinoma of the colon implanted into the liver were subjected to hepatic arterial occlusion for 30–120 min. Regrowth of the tumour after reperfusion was evaluated by immunohistological determination of S-phase activity after injection of bromodeoxyuridine. Levels of RNA and nucleotides, and energy charge, were also examined. DNA synthesis was observed in the entire tumour except in necrotic areas of controls and after 30-min ischaemia with 2-h reflow. Almost all tumoral DNA synthesis was abolished by 2 h of ischaemia, except in a few cells in the tumour periphery, which after reperfusion for 22 and 40 h grew into a band-like concentric layer. Levels of energy charge, adenosine, uridine and guanosine 5′-triphosphates, and RNA were unchanged in liver tissue after hepatic arterial occlusion but decreased in the tumour. In conclusion 30 min of ischaemia did not damage the tumour cells substantially. Ischaemia for 2 h seemed able to kill the tumour cells except those in the periphery in areas nourished by the portal vein where tumour regrowth was seen. The liver tissue was not damaged.
Haemodynamic effects of pneumoperitoneum during laparoscopic cholecystectomy: A prospective comparative study using bioimpedance cardiography
Authors: Köksoy C , Kuzu M A , Kurt I , Kurt N , Yerdel M A , Tezcan Ç , Aras N 
Published: March 2007

Abstract
The haemodynamic effects of increased intra-abdominal pressure during laparoscopic cholecystectomy in 22 patients were compared with those in 11 patients undergoing open cholecystectomy; bioimpedance cardiography was used for monitoring at predetermined time intervals. In the laparoscopy group stroke volume, cardiac and ejection velocity indices were significantly decreased and the total peripheral resistance index was significantly increased during the insufflation period when compared with preinsufflation and corresponding values in the group undergoing open operation. Routine intraoperative parameters such as heart rate and blood pressure did not show any significant change or indicate alterations in cardiovascular performance during laparoscopic procedures. Continuous non-invasive cardiovascular monitoring by bioimpedance cardiography may be useful in patients with limited cardiac function.
Giant diverticulum of the sigmoid colon
Authors: Naber A , Sliutz A-M , Freitas H 
Published: March 2007

Abstract
Giant diverticulum is a rare entity and few cases have so far been reported. It is nearly always associated with diverticular disease. There are some theories about the formation of a giant diverticulum but none is conclusive. Associated symptoms are similar to those of diverticular disease but, as with the patient reported here, the lesion may sometimes be asymptomatic. Diagnosis is easy with radiological help.
Operative procedures in patients subsequently found to be human immunodeficiency virus positive
Authors: Whitfield G , Stotter A , Graham R M , Wiselka M J 
Published: March 2007

Abstract
This study investigated the number and range of surgical procedures performed in patients subsequently found to be human immunodeficiency virus (HIV) positive. Procedures were included if they occurred during a period when the patients were likely to have been infected with HIV but unaware of their HIV status. A total of 28 operative procedures were documented in 19 (22 per cent) of 86 patients. Several operations were major and invasive. All patients had recognized risk factors for HIV infection but these had not been elicited in the surgical records. Women and patients who acquired their disease through heterosexual intercourse were more likely to have undergone surgery before a diagnosis of HIV than homosexual men. The incidence of surgical procedures in patients with HIV infection was significantly greater than in the general population of Leicestershire; however, many of these were minor and related to the management of complications associated with HIV. Surgeons are performing operations on patients who are unknowingly infected with HIV. The risk of transmission of HIV to surgeons is remote, but surgeons must be aware of risk factors for HIV infection.
Surgical management of regional lymph nodes in primary cutaneous malignant melanoma
Authors: Stone C A , Goodacre T E E 
Published: March 2007

Abstract
The management of regional lymph nodes in the patient with primary cutaneous malignant melanoma remains a contentious issue. Early removal of nodes, which may harbour occult microscopic disease before the development of clinically detectable malignant lymphadenopathy, is thought by some to confer a survival advantage and/or improve locoregional tumour control. While tumour burden at lymphadenectomy has been shown to correlate with prognosis, there are conflicting reports regarding the efficacy of elective lymph node dissection (ELND) compared with a regimen of delayed therapeutic dissection for clinically detectable nodal involvement. Evaluation of arguments for and against ELND, together with consideration of surgical morbidity and the predictability of lymphatic drainage patterns, has allowed a clinical algorithm to emerge which may identify patients who may benefit from prophylactic surgery. A chronological summary of the relevant studies is presented and the overall division of opinion regarding the efficacy of ELND is discussed.
Total mesorectal excision and local recurrence: A study of tumour spread in the mesorectum distal to rectal cancer
Authors: Scott N , Jackson P , Al-Jaberi T , Dixon M F , Quirke P , Finan P J 
Published: March 2007

Abstract
Total mesorectal excision (TME) appears to be associated with a reduced local recurrence rate following surgery for rectal cancer. Of 20 patients with rectal cancer in whom TME was performed, adenocarcinoma was found in the distal mesorectum in four. Distal mesorectal spread often extended further than intramural spread. Patients with tumour in the distal mesorectum had a worse outcome at 4-year follow-up, a greater risk of local recurrence and an increased frequency of distant metastasis. Distal tumour spread is, therefore, a marker of poor prognosis in rectal cancer. This study provides further evidence that incomplete excision of the mesorectum contributes to local recurrence in a proportion of patients with rectal cancer, particularly in those with tumours in the middle and lower third of the rectum.
Efficacy of tumoricidal agents in vitro and in vivo
Authors: Docherty J G , McGregor J R , Purdie C A , Galloway D J , O'Dwyer P J 
Published: March 2007

Abstract
Implantation of exfoliated tumour cells can give rise to local recurrence of colorectal cancer and it has been recommended that the bowel lumen be lavaged with a tumoricidal agent. This study identified which tumoricidal agents are currently used in Scotland and investigated their efficacy in vitro and in vivo. Cytotoxic efficacy was tested in vitro by a clonogenic assay and in vivo by a rat model with viable intraluminal tumour cells. Overall 70 per cent of surgeons used a tumoricidal agent during colorectal cancer surgery. Povidone-iodine, sodium hypochlorite and chlorhexidine-cetrimide were all effective at killing tumour cells in vitro but were all inactivated by the presence of 25 per cent whole blood in vitro. With 105 cells in vivo povidone-iodine and sodium hypochlorite significantly (P &lt; 0·02) reduced the incidence of tumour growth while chlorhexidine-cetrimide had no significant effect. With 106 cells povidone-iodine had no effect on the incidence of tumour growth. Tumoricidal agents have effective cytotoxicity in vitro but are only weakly cytotoxic in vivo.
Total thyroidectomy in the treatment of thyroid carcinoma in childhood
Authors: Stael A P M , Plukker J Th M , Piers D A , Rouwé C W , Vermey A 
Published: March 2007

Abstract
Between 1974 and 1993 ten girls and six boys aged 6–16 years underwent total thyroidectomy, with therapeutic selective neck dissection in six patients. All were treated after operation with radioactive iodine (131I) for ablation of thyroid tissue remnants. Papillary carcinoma occurred in ten patients, follicular carcinoma in two and medullary thyroid lesions in four. The patients were followed for a median of 11·5 (range 1–20) years with regular determinations of serum thyroglobulin levels and 131I whole-body scanning when indicated. Only one patient had a slight increase in thyroglobulin levels without evidence of disease on further screening. In children with medullary lesions the serum levels of basal and pentagastrin-stimulated calcitonin remained normal. Currently all patients are alive and without disease. Hypocalcaemia lasting for more than 1 year was observed in one patient. Recurrent nerves were not injured accidentally, but because of tumour invasion two of 32 recurrent nerves had to be sacrificed. This surgical approach is safe and well tolerated in children.
Liver resection without blood transfusion
Authors: Gozzetti G , Mazziotti A , Grazi G L , Jovine E , Gallucci A , Gruttadauria S , Frena A , Morganti M , Ercolani G , Masetti M , Pierangeli F 
Published: March 2007

Abstract
A retrospective study was carried out of 522 elective liver resections to determine the impact of blood transfusion on the immediate postoperative outcome and on long-term survival. The number of liver resections without transfusion has increased in recent years, as a result of improvement in surgical technique with less blood loss during operation and more careful choice of the timing of transfusion. In resections carried out in the past 5 years, the indication for intraoperative transfusion was restricted and the decision was made jointly by the surgeon and anaesthetist, and in any case only if the haematocrit was below 25 per cent. Of resections carried out in the past 2 years, 59 per cent did not require intraoperative transfusion. Postoperative deaths and complications were related to blood transfusion, particularly in patients with cirrhosis, in whom stepwise logistic regression analysis showed that transfusion was the only factor that correlated significantly with complications. Transfusion also affected the long-term survival of patients operated on for hepatocellular carcinoma and colorectal carcinoma metastases in univariate analysis and was the only factor shown by multivariate analysis to correlate with survival for hepatocellular carcinoma in patients with cirrhosis.
Role of nitric oxide in lung injury associated with experimental acute pancreatitis
Authors: O'Donovan D A , Kelly C J , Abdih H , Bouchier-Hayes D , Watson R W G , Redmond H P , Burke P E , Bouchier-Hayes D A 
Published: March 2007

Abstract
This study evaluated the effect of varying the synthesis of nitric oxide with sodium nitroprusside or N-nitro-L-arginine methyl ester (L-NAME) in a pancreatitis-lung injury model. Rats (n = 45) were randomized to control or caerulein-induced pancreatitis groups, treated with saline, sodium nitroprusside (0·4 μg/kg) or l-NAME (10 mg/kg). Myeloperoxidase activity was used as a measure of neutrophil infiltration. Wet to dry (W:D) lung weight and bronchoalveolar lavage (BAL) protein concentrations were used to assess vascular leakage. Pancreatitis was shown to induce pulmonary neutrophil influx: mean(s.e.m.) myeloperoxidase activity 6·79(0·5) units/g in caerulein-treated animals versus 2·08(0·5) units/g in controls (P &lt; 0·001). Animals with pancreatitis showed increased microvascular leakage compared with controls (mean(s.e.m.) W:D lung weight 7·01(0·5) versus 2·85(0·2), P &lt; 0·001; BAL protein concentration 2539(222) versus 347(32) μg/ml, P &lt; 0·001). Compared with the saline-treated pancreatitis group, these changes were reduced by sodium nitroprusside (mean(s.e.m.) myeloperoxidase activity to 2·5(0·4) units/g, P &lt; 0·001; W:D lung weight to 3·8(0·37), P &lt; 0·001; BAL protein concentration 1389(182) μg/ml, P &lt; 0·05). L-NAME exacerbated the pancreatitis-induced pulmonary oedema (W:D lung weight increased to 11·96(0·6), P &lt; 0·001), protein leakage (BAL protein concentration rose to 3707(309) μg/ml, P &lt; 0·05) and neutrophil infiltration (myeloperoxidase activity increased to 9·01(0·3) units/g, P &lt; 0·05). These data suggest that, in vivo, nitric oxide inhibits pancreatitis-induced lung injury, possibly in part by inhibiting pulmonary neutrophil influx.
Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer
Authors: Castillo C Fernández-Del , Rattner D W , Warshaw A L 
Published: March 2007

Abstract
A total of 114 patients with pancreatic cancer and no evidence of metastatic disease by computed tomography underwent laparoscopy. Intra-abdominal spread was present in 27 patients (24 per cent). Metastases were 2·4 times more common in tumours of the distal pancreas (11 of 25, 44 per cent) than in pancreatic head tumours (16 of 89, 18 per cent) (P &lt; 0·05). None of the 27 patients with metastases underwent further surgery. Of the 87 patients without metastatic spread, 42 were found to have vascular invasion by angiography and were offered radiation therapy. Thirty of 40 patients explored surgically were resected; two of the remaining ten had peritoneal spread that had been missed at laparoscopy (false-negative rate of 7 per cent). Cytological examination of peritoneal washings was performed in 94 patients at the time of laparoscopy; cytology was positive in 16 (17 per cent). There was a significant correlation between positive cytology and presence of visible liver or peritoneal metastases (ten of 22 with metastases versus six of 72 without, P &lt; 0·001). Positive cytology was present in six patients (8 per cent) without visible metastases, but none had resectable disease.
Transjugular intrahepatic portasystemic stent—shunt in the treatment of variceal haemorrhage
Authors: Jalan R , Redhead D N , Hayes P C 
Published: March 2007

Abstract
The transjugular intrahepatic portasystemic stent-shunt (TIPSS) is a side-to-side portocaval shunt, performed by interventional radiological methods, linking the hepatic and portal veins through the liver parenchyma with an expandable metal stent. The technique can be performed successfully in over 90 per cent of patients. The procedure-related mortality rate is about 1 per cent, mainly from intraperitoneal bleeding. The main indications for TIPSS insertion are control of acute variceal bleeding in patients with cirrhosis that is refractory to sclerotherapy and recurrent variceal haemorrhage despite sclerotherapy or band ligation. TIPSS insertion is followed by variceal rebleeding in about 10–20 per cent of cases, encephalopathy in 10–20 per cent, transient deterioration of liver function in 25–35 per cent and subsequent shunt dysfunction over a 6–12-month period in 15–60 per cent. The final place of TIPSS insertion in the management of portal hypertension is being evaluated in controlled studies, but its use in the treatment of uncontrolled variceal haemorrhage seems assured.