bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compliance changes in in-situ femoropopliteal bypass vein grafts
Authors: Beard J D , Fairgrieve J 
Published: March 2007

Abstract
Changes in wall structure, including neo-intimal proliferation and medial fibrosis, have been implicated as a cause of late occlusion in reversed femoropopliteal vein grafts. These changes can be measured indirectly as a fall in compliance. It has been suggested that long-term patency might be improved by the in situ technique because the nutrient vasa vasorum are left intact and therefore wall structure preserved. We have measured the compliance of 62 in situ vein grafts, with times after operation ranging from 2 days to 6 years, and also compared the compliance changes, in the first 3 months after operation, of 15 undisturbed in situ vein grafts with 15 fully mobilized in situ vein grafts. Compliance was derived non-invasively from the pulse wave velocity using Doppler ultrasound. There was a significant fall in compliance after operation (P &lt; 0·001) and no difference could be found between the undisturbed and mobilized in situ vein grafts (P &gt; 0·1). Histological examination of 6 grafts suggested that the fall in compliance was due to neo-intimal proliferation which still occurred although medialfibrosis was reduced. Any potential improvement in longterm patency rates using the in situ technique must be due to other factors.
Intra-operative fibreoptic enteroscopy for bleeding lesions in the small intestine
Authors: Lau W Y , Fan S T , Chu K W , Yip W C , Poon G P , Wong K K 
Published: March 2007

Abstract
Twenty-five patients with gastrointestinal bleeding proved to have lesions in the small intestine. Intra-operative fibreoptic enteroscopy was performed on seven patients, in six patients through the anus and in one patient through an enterotomy and the anus. The indications for fibreoptic enteroscopy were inability to find the lesions in the 3 patients, multiple small lesions in 3 patients and to rule out suspicious pathology in the jejunum shown on a small bowel enema in a patient with ieal ulcers. In all instances, the fibreoptic enteroscopy was useful in localizing lesions, in detecting additional lesions and in ruling out the suspicious lesions. It can be performed easily and is safe. No complication developed from its use in this series.
Chemical composition of common bile duct stones
Authors: Whiting M J , McK. Watts J 
Published: March 2007

Abstract
The common bile duct stones obtained from 148 patients were analysed chemically for cholesterol, calcium and bilirubin. When stones were present in both the common bile duct and gallbladder at the time of surgery, the common duct stones were similar in chemical composition to gallbladder stones in the majority of cases and were predominantly cholesterol-type stones. However, common bile duct stones from patients whose gallbladders had been removed at least one year before the detection of common duct stones contained less cholesterol and more bilirubin than common bile duct stones which were associated with gallbladder stones. Thirty per cent of these stones contained suture material in the centre of the stone. Overall, the results indicate that common bile duct stones are more likely to be pigment type than gallbladder stones, especially if the common duct stones are large, have formed in the duct and become symptomatic less than 12 years after cholecystectomy. Non-absorbable suture material should be avoided in surgery involving the common bile duct.
Experimental colorectal cancer: The relationship of diet and faecal bile acid concentration to tumour induction
Authors: Galloway D J , Owen R W , Jarrett Freda , Boyle P , Hill M J , George W D 
Published: March 2007

Abstract
Epidemiological studies have consistently suggested an aetiological relationship between certain dietary constituents, faecal bile acid (FBA) concentration and colorectal cancer. This study was designed to examine the effect of the dietary manipulation of fat and fibre on tumour induction and on various faecal characteristics in Albino Swiss rats. A total of 232 animals were maintained on one of four different diets for 4, 20 and 28 weeks respectively. The diets were classified as high fat high fibre, low fat high fibre, high fat low fibre and low fat low fibre. The groups were further sub-divided according to the administration of systemic azoxymethane (10 mg/kg per week) or saline over 12 consecutive weeks. The high fat low fibre diet was associated with the highest risk for tumour production and the low fat high fibre diet with the lowest risk. Statistically significant differences between all the diets were noted with the exception of a comparison between the high fat high fibre and low fat high fibre diets. The highest total concentration of free FBA was found in the faeces from animals fed low fibre containing diets. The results show a clear influence of both fat and fibre on tumour induction while, in this model, fibre was the principle determinant of faecal bile acid concentration.
The association of impaired neutrophil chemotaxis with postoperative surgical sepsis
Authors: Duignan J P , Collinst P B , Johnson A H , Bouchier-Hayes D 
Published: March 2007

Abstract
Postoperative sepsis remains a major problem in current surgical practice. This study assesses the predictive role of neutrophil chemotaxis in the development of sepsis in surgical patients. Neutrophil chemotaxis was measured in 30 cancer patients undergoing gastrointestinal surgery and in 26 healthy age and sex-matched controls. Neutrophil chemotaxis was significantly reduced (P &lt; 0·02) in the patients (mean 79·2 μm ± 2·7 s.e.m.) compared with the controls (mean 86·8 μm ± 1·9 s.e.m.). In the entire patient group neutrophil chemotaxis did not change to any appreciable extent following surgery. However, in the seven patients who developed postoperative septic complications, chemotaxis, which was similar to control levels in the pre-operative stage, declined significantly following surgery. Pre-operative values for the septic group of patients are 92·4 μm ± 4·02 s.e.m. These declined to 73·4 μm ± 3·15 s.e.m. (P &lt; 0·05) and to 68·2 μm ± 2·89 s.e.m. (P &lt; 0·05), 5–8 days (early) and 10–14 days (late) postoperatively respectively. Neutrophil chemotaxis in the non-septic group of patients did not alter over this same period. The data suggest that the onset of postoperative sepsis in patients is accompanied by impairment of chemotactic properties in their neutrophils. However, it is also evident that measurement of this variable in patients before operation does not help to define an ‘at risk’ group for the development of postoperative sepsis.
Prognostic factors in breast cancer and the development of a prognostic index
Authors: Bryan R M , Mercer R J , Bennett R C , Rennie G C 
Published: March 2007

Abstract
A number of different factors are known to be correlated with survival of patients with breast cancer. Among these are lymph node status, tumour size, oestrogen receptor (ER), progesterone receptor (PR) and androgen receptor (AR) status. The purpose of this study was to investigate the relative significance of these factors and use this information to construct a prognostic index capable of predicting survival. These factors together with age and menopausal status were studied and correlated with prognosis in 796 women with primary breast cancer. The data were analysed in a stepwise manner by the Cox proportional hazards regression technique. Statistically, &gt;3 nodes involved gave the worst prognosis (P &lt;0·001). This was followed by ER if &lt;10 fmol/mg cytosol protein (P &lt; 0·001), PR if &lt; 10 fmol (P &lt; 0·01), &gt; 0 lymph nodes involved (P &lt;0·01) and the number of years over age 65 (P &lt;0·01). When these factors were accounted for, tumour size, menopausal status and AR did not significantly improve prediction of survival. The significant factors were incorporated into a prognostic index: I = N + E + P + A, where N = 0 if no nodes involved, 13 if 1–3 nodes involved and 31 if &gt; 3 nodes involved, E = 15 if ER &lt;10 fmol, P = 12·5 if PR &lt;10 fmol and A = number of years over 65. Using this index five year survival curves were constructed corresponding to groups of patients with widely differing prognoses. Predicted five year survival ranged from 96 to 12 per cent.
Increased activities of thymidine kinase isozymes in human mammary tumours
Authors: Sakamoto S , Iwama T , Ebuchi M , Tsukada K , Sagara T , Kawasaki T , Murakami S , Kasahara N , Kudo H , Okamoto R 
Published: March 2007

Abstract
Thymidine kinase, the enzyme in the pyrimidine salvage pathway, and its isozymes were examined in 10 specimens of normal mammary gland, 10 fibroadenomas and 11 adenocarcinomas in human breasts. The average thymidine kinase activities in fibroadenomas and adenocarcinomas were about 3 and 8 times that in normal mammary gland. The mammary thymidine kinase isozymes were separated into two types by diethylaminoethyl (DEAE) cellulose column chromatography. The activity of the thymidine kinase isozyme eluted with 0·1 m sodium chloride in buffer was twofold higher in fibroadenomas and fourfold higher in adenocarcinomas than that in normal tissue. In adenocarcinomas, but not fibroadenomas, the activity of the other isozyme eluted with buffer alone was increased to 22-fold that in normal tissues. As the activity of the latter isozyme was not affected by deoxycytidine triphosphate, it may be involved closely in DNA replication.
Multifactorial study of prognostic factors in differentiated thyroid carcinoma and a re-evaluation of the importance of age
Authors: Bacourt F , Asselain B , Savoie J C , D'Hubert E , Massin J P , Doucet G , Leger A , Garnier H 
Published: March 2007

Abstract
A multivariate analysis of prognostic factors has been carried out with 375 cases of differentiated thyroid cancer (DTC) treated in the same centre by total thyroidectomy and 131I therapy. The patients have been followed for 5 to 23 years. The isolated prognostic roles of age, sex, clinical stage and histology were confirmed, but these factors were found to be strongly interrelated. Multifactorial analysis was conducted following Cox's model. It demonstrated that the prevalent role of clinical staging (nodular versus labar or massive form) is as important as the initial presence of metastases (P = 0·0001). Histological assessment of differentiation, age and sex were of lesser importance. Thus, the most significant prognostic variable is clinical stage. These data must be taken into account when formulating management protocols for DTC.
Familial medullary thyroid carcinoma without associated endocrinopathies: A distinct clinical entity
Authors: Farndon J R , Leightt G S , Dilley W G , Baylin S B , Smallridge R C , Harrison T S , Wells S A 
Published: March 2007

Abstract
In an evaluation of 213 patients from 15 kindreds with familial medullary thyroid carcinoma (MTC), we detected 41 subjects from two kindreds (L and O) who had MTC but no extra-thyroidal manifestations (hyperparathyroidism, phaeochromocytomas or mucosal neuromas) of multiple endocrine neoplasia (MEN) type 11a or 11b. In screening 178 members of the L and O kindreds, we found no evidence that any of them had died from MTC. To assess whether the malignancy was relatively indolent in these families, 20 selected subjects from the two kindreds were compared with 33 MEN IIa subjects. Both groups had clinically occult disease which was diagnosed biochemically by documenting elevated plasma calcitonin (CT) levels following stimulation with intravenous calcium and pentagastrin. There were no differences in the peak stimulated plasma CT levels at the time of diagnosis (1055 ± 236 pg/ml versus 1096 ± 191 pg/ml) or the incidence of regional lymph node metastases (0/20 versus 1/33) in the two groups. The mean age at diagnosis, however, was significantly higher in patients of the L and O kindreds than in patients with MEN 11a (43·1 ± 3·4 years versus 21·1 ± 2·2 years; P &lt; 0·001) indicating that in the two kindreds the MTC either developed at a later age or grew more slowly. This study demonstrates that MTC may occur in a familial pattern distinct from its presentation as MEN IIa or MEN IIb. In this setting it appears to be the least aggressive form of MTC yet described.
Incidence of bile reflux in gastric ulcer and after partial gastrectomy
Authors: Poxon Valerie , Hogg Barbara , Youngs Denise , Morris D L , Keighley M R B 
Published: March 2007

Abstract
Duodenogastric bile reflux (DGBR) is reported to be increased in patients with gastric ulcer (GU) and following Billroth I partial gastrectomy (BIPG). pH, total bacterial counts, and total and free bile acids were measured in gastric juice aspirated hourly for 24 h in 6 patients with GU, 7 patients with a BIPG performed for GU and in 8 healthy normal controls. Intragastric pH was significantly higher in the BI PG group during the day (P &lt; 0·001) and at night (P &lt; 0·001) compared with normals and the GU group. There were no differences between GUs and normal patients. Bile acid concentrations in the gastric juice were not significantly different between GU and control groups over the 24 h. Median and range values were 0·14 (0·06–0·52) mmol l−1 in GU patients and 0·14 (0·05–0·67) mmol l−1 in the normals. However total bile acid concentrations were significantly greater in the BIPG group (0·23, 0·04–0·84) compared with GU or controls. (P = 0·04, P = 0·02). Our data do not support the role of DGBR in the pathogenesis of GU, but deoxycholic acid was detected in significantly greater amounts in BIPG subjects than controls (χ2 = 12·94, P &lt;0·001) or GU subjects (none detected) and may be important in the pathogenesis of gastric stump cancer.
Metabolic changes in the non-insulin-dependent diabetic undergoing minor surgery: Effect of glucose—insulin—potassium infusion
Authors: Thompson J , Husband D J , Thai A C , Alberti K G M M 
Published: March 2007

Abstract
We have compared the metabolic response to minor surgery in the non-insulin dependent diabetic patient with that in the non-diabetic, using transurethral surgery under general anaesthesia as a model. Pre-operative blood glucose and 3-hydroxybutyrate concentrations were higher in the diabetic patients, but the response to surgery did not differ. The postoperative cortisol response was lower in the diabetic patients. Glucose insulin potassium infusion (GIK) resulted in lower plasma non-esterified fatty acid, and blood 3-hydroxybutyrate and glycerol concentrations, with markedly higher serum insulin levels compared to patients managed with a ‘no insulin’ regimen. Blood glucose however was not significantly different except at 2 h postoperatively. Blood metabolite and serum insulin concentrations in the diabetic patients were closer to those in non-diabetic patients in the group not given insulin, than in those given GIK. Rather than rendering the diabetic patient the same as the non-diabetic, GIK produces a further abnormal state which is probably of little benefit. We conclude that there is no indication for the use of insulin in the well or moderately well-controlled non-insulin dependent diabetic patient undergoing minor surgery, provided that glucose containing fluids are not given.
Stripping the long saphenous vein: Peroperative retrograde saphenography in patients with and without venous ulceration
Authors: Sutton R , Darke S G 
Published: March 2007

Abstract
Peroperative retrograde saphenography was used to study 80 incompetent long saphenous veins (LSV) in 60 patients with primary varicose veins. In 53 limbs presentation was uncomplicated (group A, 40 patients); in 27 limbs there was ulceration (group B, 20 patients). All limbs in group B had a normal deep system as shown pre-operatively by ascending and descending venograpy. Varicose changes were found in 52 (65 per cent) of 80 LSV; the overall mean length of normal vein seen was 16cm. The incompetent LSV appears unlikely to be suitable for arterial replacement. All valves identified on operative saphenography above the knee appeared incompetent. In only 9 LSV of group B were there recognizable valves either above or below the knee, significantly fewer than 34 of group A (P &lt;0·05). This finding suggests that a deficiency of saphenous valves may contribute to the development of venous ulceration. Hunterian perforators of variable size were seen on 70 saphenograms (87 per cent) passing directly from the LSV to the superficial femoral vein. Stripping of the incompetent LSV will disconnect such perforators from an incompetent system and may thus reduce the incidence of both recurrent varicose veins and persistent ulceration.
Radiation-induced soft-tissue sarcoma
Authors: Davidson T , Westbury G , Harmer C L 
Published: March 2007

Abstract
Twenty patients with soft-tissue sarcomas arising within previously irradiated fields have been analysed. The initial radiation dose ranged from 8·8 to 70 Gy, comprising either orthovoltage or megavoltage treatment. The latent interval following radiotherapy ranged from 7 to 45 years (mean 16·8 years). The commonest histological subtype was malignant fibrous histiocytoma. Four patients required forequarter amputation. The 5-year survival was only 14 per cent. The high morbidity and mortality accompanying post-radiation sarcomas must be borne in mind when the choice between therapeutic options for potentially curable cancers is finely balanced.
Intragastric bile acids and histological changes in gastric mucosa
Authors: Houghton P W J , Mortensen N J McC , Thomas W E G , Cooper M J , Morgan A P , Burton Patricia 
Published: March 2007

Abstract
Multiple gastric biopsies and gastric juice aspirates were taken in 108 patients undergoing routine or review gastroscopy for a variety of upper gastrointestinal disorders. The gastric juice was measured for free and total bile acids and the biopsies examined for premalignant mucosal changes. Total bile acid levels were significantly higher in patients with atrophic gastritis, intestinal metaplasia and dysplasia but not chronic gastritis. There was no correlation between the severity of the dysplasia and total bile acid levels. Free bile acid levels were significantly higher in patients with atrophic gastritis but not in patients with chronic gastritis, intestinal metaplasia or dysplasia. These results suggest that intragastric bile acids may be implicated in premalignant histological changes of gastric mucosa and thus play a part in gastric carcinogenesis.
The role of pelvic floor denervation in the aetiology of idiopathic faecal incontinence
Authors: Womack N R , Morrison J F B , Williams N S 
Published: March 2007

Abstract
Weakness of the muscles of the pelvic floor and external anal sphincter may in theory be caused by a traction injury to the pelvic nerves incurred as a result of the excessive perineal descent that accompanies straining in the descending perineum syndrome (DPS). To investigate the role of this weakness in the aetiology of idiopathic faecal incontinence (IFI), measurements of perineal position, puborectalis mean fibre density (MFD), anal canal pressures, rectal sensation, capacity, and compliance were made in continent (DPS alone, n = 20) and incontinent (DPS + I, n = 19) patients with DPS, and a group of age and sex matched control subjects (n = 20). Perineal descent on straining was greater in DPS alone than in DPS + I. Puborectalis MFD was raised by similar degree in both DPS groups compared with the control subjects, and external anal sphincter function, assessed as voluntary squeeze pressure, was impaired by similar degree in DPS + I and DPS alone compared with the control subjects. Maximal basal anal canal pressure and rectal compliance were significantly reduced in DPS + I compared with DPS alone and the control subjects. Thus IFI did not result from progression of neurogenic muscle weakness, but occurred when there was also diminished internal anal sphincter tone and reduced rectal compliance.
Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children
Authors: Hall R I , Lavelle M I , Venables C W 
Published: March 2007

Abstract
Major pancreatic injuries in children are uncommon but potentially very serious. They usually occur in active young boys following characteristic accidents. Despite this they frequently go unrecognized for prolonged periods. Four patients with delayed recognition of blunt pancreatic trauma are described. The presence of pancreatic injury was identified by hyperamylasaemia in every case. Ultrasound and CT scanning were helpful in identifying pseudocysts but accurate pre-operative diagnosis of main duct disruption required endoscopic retrograde cholangio-pancreatography (ERCP). Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreaticojejunostomy in one case. Two patients with distal lacerations were treated by distal pancreatectomy and oversewing of the remnant. All four patients recovered and were well at follow-up. Early ERCP is the only reliable method of identifying duct injuries which require urgent surgery. It should be considered in all children with blunt pancreatic trauma.
Simple suture with or without proximal gastric vagotomy for perforated duodenal ulcer
Authors: Ceneviva R , Silva O De Castro E , Castelfranchi P L , Módena J L P , Santos R F 
Published: March 2007

Abstract
To assess the results of proximal gastric vagotomy (PGV) in the definitive treatment of perforated duodenal ulcers, a prospective study was carried out comparing PGV in association with omental patch suture (PGV + S) with the simple omental patch suture procedure (S). The PGV + S series consisted of 38 consecutive patients with perforated duodenal ulcer and the S series consisted of 38 survivors of a similar series of 41 consecutive patients. Surgical mortality was zero in the PGV + S series. The patients were followed up for 1 to 7 years. No cases of dumping or diarrhoea were observed. Thirty-three patients in the PGV + S series (87 per cent) were classified as Visick grade I and only two (5 per cent) as Visick grade IV. In contrast, 11 patients (29 per cent) were Visick grade I and 22 (58 per cent) were Visick grade IV in the S series. Recurrent ulcer was detected endoscopically in 58 per cent of the patients who had been treated with simple suture and in only 5 per cent after suture plus PGV. PGV is a safe operation with a negligible morbidity rate and with a significant rate of effective control of ulcer disease. Depending on the general condition of the patient and on the surgeon's skill, it appears preferable to treat not only the acute perforation but also the ulcer disease by PGV.
Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients
Authors: Korenaga D , Haraguchi M , Tsujitani S , Okamura T , Tamada R , Sugimachi K 
Published: March 2007

Abstract
Of 568 patients with mucosal carcinoma of the stomach, only 11 (1·9 per cent) had a lymph node metastasis. The clinicopathological findings in these 11 patients are reviewed. Diameters of the lesions were over 2·0 cm. Seven were located in the body of the stomach and four in the antrum. Nine showed depressed lesions comprised of poorly differentiated adenocarcinoma and two were classed as elevated lesions consisting of well and moderately differentiated adenocarcinomas. There were six with accompanying peptic ulcers, all of which revealed depressed lesions with poorly differentiated adenocarcinoma. Metastases to proximal perigastric lymph nodes were found in eight while there were three with involvement of distant lymph nodes. All patients were surgically treated and all are doing well except for one who died of hepatic failure one month after operation. We recommend that the standard operation with lymph node dissection is essential, even in cases of mucosal carcinoma.