bluuebunny/crossref_metadata_2025_split huggingface dataset:
Necrosectomy and postoperative local lavage in necrotizing pancreatitis
Authors: Beger H G , Büchler M , Bittner R , Block S , Nevalainen T , Roscher R 
Published: March 2007

Abstract
Necrosectomy with postoperative continuous local lavage was performed in a prospective study involving 95 patients with necrotizing pancreatitis. In the same period 567 patients with oedematous-interstitial pancreatitis were treated non-operatively with a hospital mortality rate of 0·7 per cent. In patients with necrotizing pancreatitis the median Ranson criteria score was 4·5 points; operation was required at a median of 7 days after the onset of symptoms because of non-response to conservative treatment. In all, 59 per cent of the patients (56 out of 95) developed extended intrapancreatic parenchymal necrosis, 70 per cent had ascites, and 66 per cent had intra- and extrapancreatic necrosis; 42 per cent of the patients had bacterial infection of the necrotic tissue. For lavage a median of 8l/24 h of fluid were instilled postoperatively for 25 days (median). The lavage fluid showed high levels of immunoreactive trypsin, phospholipase A2, and endotoxin in the early postoperative period. Hospital mortality rate was 8·4 per cent. Necrosectomy and continuous postoperative lavage can achieve high survival rates in patients with necrotizing pancreatitis. Postoperative local lavage allows the continuous non-operative evacuation of biologically active compounds and devitalized tissue, and avoids damage to remaining vital exocrine and endocrine pancreatic tissue.
Relative merits of ultrasound and intravenous urography in the investigation of the urinary tract
Authors: Jagjivan B , Moore D J , Naik D R 
Published: March 2007

Abstract
Three hundred and fifty adult patients referred for intravenous urography were entered into a prospective double blind trial comparing intravenous urography with real time ultrasound. The study was performed to clarify the relative merits of the two techniques. Our results show that ultrasound and a plain abdominal radiograph should be the examination of first choice in most circumstances. This is particularly so in vague abdominal pain and in recurrent urinary tract infections where intravenous urography can usually be omitted or used only as a secondary investigation for further evaluation of abnormal ultrasound findings. In acute renal colic, intravenous urography should be the primary investigation. In macroscopic haematuria, initial examination by ultrasound would reliably diagnose mass lesions, show whether the lesion is cystic or solid and assess possible spread. Normal ultrasound does not exclude haematuria due to ureteric lesions or bladder lesions and intravenous urography is recommended.
Venous mesenteric infarction: A particular entity
Authors: Clavien P-A , Dürig M , Harder F 
Published: March 2007

Abstract
Ninety-eight patients with documented mesenteric infarction during a 19-year period were reviewed. In 13 patients infarction was due to a mesenteric venous thrombosis (MVT). Patients with MVT distinguished themselves from those having another aetiology by: (1) longer history of pain before admission (median 8 days, P&lt;0·0001); (2) typical appearance of the bowel at laparotomy (10/13); (3) a localized segment of ischaemic jejunum or ileum of less than 120 cm in length (12/13) allowing better operability at the first laparotomy (P = 0·006). In hospital the mortality was lower for venous mesenteric infarction (5/13, 38 per cent) than for mesenteric infarction of other aetiologies (70/85, 82 per cent) (P = 0·002). Patients with primary venous mesenteric infarction showed a better survival rate (one death in eight patients) than patients with associated diseases such as liver cirrhosis, sepsis or previous operation who had a poor prognosis with a mortality comparable to other aetiologies of acute bowel ischaemia (four deaths in five patients). Since the high recurrence rate of this disease in the early postoperative period was due to residual venous thrombosis and to a hypercoagulable state, a wide bowel resection is recommended followed by early and long-term anticoagulation. Thrombectomy is probably inefficient since it removes only centrally located thrombi and leaves peripheral occlusion, which is responsible for the recurrence.
Management of pleomorphic adenoma of the parotid
Authors: Maynard J D 
Published: March 2007

Abstract
A series of 336 parotidectomies, carried out for benign disease has been followed for up to 20 years. One hundred and thirty primary pleomorphic adenomas were treated by wide excision of the tumour after identification of the facial nerve. Recurrence occurred in only one patient and, although 20 patients (15 per cent) experienced some degree of facial nerve weakness postoperatively, there was only one case of permanent weakness.
Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices
Authors: Howard E R , Stringer M D , Mowat A P 
Published: March 2007

Abstract
A total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow-up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in children.
Cerebral angiography for cerebrovascular disease: The risks
Authors: Leow K , Murie J A 
Published: March 2007

Abstract
Cerebral angiography is still suggested as a first line investigation for patients with putative transient ischaemic attacks (TIA) and it is considered by most surgeons as a necessary prelude to carotid endarterectomy. That conventional cerebral angiography involves risk is well known, although the magnitude of this risk is not. Prospective studies of cerebral complications from this technique, published over the last decade, have been analysed to show that the major stroke rate after conventional cerebral angiography for patients with TI As is likely to be about 2.4 per cent. This must be taken into account if the true morbidity of carotid endarterectomy is to be appreciated (assuming conventional angiograms have been used). Furthermore, since many sufferers are assessed by angiography but not submitted to surgery, a policy of conventional angiography for patients with TI As puts a far greater number at risk than that actually having carotid endarterectomy.
Results of excision of a cervical rib in patients with the thoracic outlet syndrome
Authors: Brown S C W , Charlesworth D 
Published: March 2007

Abstract
Excision of a cervical rib in patients with the thoracic outlet syndrome has been the subject of debate. One surgeon's experience of 23 cervical rib excisions is presented. Ten operations produced a complete cure, eleven improvement, and two no change in the patient's condition. Of 15 cases with neurological symptoms alone, 9 were cured, 5 improved and 1 was not helped; in contrast, of 8 patients with vascular symptoms, I was cured, 6 were improved and I was not helped. We conclude that cervical rib resection is the correct treatment for patients whose symptoms are predominantly neurological. Rib resection alone may not be sufficient in patients with vascular symptoms. The management of a cervical rib with vascular involvement is discussed.
Role of duodenal bile crystal analysis in the investigation of ‘idiopathic’ pancreatitis
Authors: Neoptolemos J P , Davidson B R , Winder A F , Vallance D 
Published: March 2007

Abstract
Duodenal bile crystal analysis for the detection of gallstones was assessed in 26 patients with acute pancreatitis of known aetiology (11 attributable to gallstones and 15 to alcohol) and in 37 patients without a history of acute pancreatitis (21 with gallstones and 16 without). The sensitivity was 64–67 per cent and the specificity was 94–100 per cent in these groups. Analysis of duodenal bile from 14 patients with ‘idiopathic’ pancreatitis revealed calcium bilirubinate crystals (but not cholesterol crystals) in 5 patients (36 per cent). Gallstones were confirmed at cholecystectomy in three of these patients and also in one other patient who had a gallstone on a ‘late’ ultrasound examination but was negative for crystals. Thus 29 per cent of the original ‘idiopathic’ group had gallstones confirmed. Gallstone analysis showed that pigment stones were present in 7 of 31 (23 per cent) non-pancreatitis controls compared with 9 of 13 (69 per cent) pancreatitis patients (P = 0·0048). These results suggest that duodenal bile crystal analysis (involving both calcium bilirubinate and cholesterol crystals) may be a useful technique for the investigation of patients with ‘idiopathic’ pancreatitis.
Surgical management of chronic pancreatitis: Long-term results in 141 patients
Authors: Mannell Aylwyn , Adson M A , McIlrath D C , Ilstrup D M 
Published: March 2007

Abstract
The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to ‘burn out’, while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8·5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0·7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P &lt; 0·02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results. However quality of life and pancreatic function were severely impaired by 80–95 per cent distal resections and by total pancreatectomy. An extended proximal resection is suggested for patients with diffuse disease and non-dilated ducts.
Tumour calcification following repeated hepatic de-arterialization in patients: a preliminary communication
Authors: Bengmark S , Jeppsson B , Lunderquist A , Tranberg K-G , Persson B 
Published: March 2007

Abstract
A novel method of repeated hepatic de-arterialization is presented. A vascular occluder is placed around the hepatic artery and connected to an injection port. The hepatic artery can thereafter be occluded repeatedly. Patients with irresectable liver metastases from colorectal cancers were treated with occlusions of the hepatic artery for 1 h twice daily, in combination with intraperitoneal cyclic administration of 5-fluorouracil. The first three patients treated are presented. They all exhibited massive tumour calcifications in the liver reflecting tumour necrosis and resorption. This therapeutic principle must undergo further clinical trials.
Gastro-oesophageal reflux and intestinal malrotation in children
Authors: Kumar D , Brereton R J , Spitz L , Hall Christine M 
Published: March 2007

Abstract
In a series of 74 children undergoing Nissen fundoplication for persistent gastro-oesophageal reflux unresponsive to intensive medical treatment, there was an unexpectedly high incidence (54 per cent, n = 40) of intestinal malrotation. The series was not homogeneous, 25 of the children having reflux as a complication of a serious congenital abnormality (48 per cent incidence of intestinal malrotation), and 49 presenting with ‘idiopathic’ reflux (57 per cent incidence of intestinal malrotation). Intestinal malrotation is best detected pre-operatively by careful barium radiology, requiring clinicians to be aware of the association. In our experience, in children over the age of 3 months, both an antireflux operation and Ladd's procedure are often necessary to stop gastro-oesophageal reflux when an intestinal malrotation is present.
Surgical management of substernal goitre
Authors: Michel L A , Bradpiece H A 
Published: March 2007

Abstract
This paper presents the clinical features and problems in the management of 34 patients with substernal goitre. Complete evaluation of the mediastinum relied on computed tomography. Thyroid function tests were performed routinely and showed a clinically underestimated incidence of hyperthyroidism (44 per cent). The incidence of occult malignancy in substernal goitres was high (12 per cent). In the majority of patients (88 per cent) the substernal goitres were removed by a collar incision. Four cases of goitres located in a retrotracheal position required a combined cervical and sternotomy approach. None of the 34 patients died. Transient postoperative hypocalcaemia was found in 41 per cent of our patients. The presence of a substernal goitre is an indication for resection based on the risk of malignancy, the risk of acute respiratory distress, the high incidence of thyrotoxicity and a low surgical morbidity.
Non-operative management of retroperitoneal fibrosis
Authors: Higgins P M , Bennett-Jones D N , Naish P F , Aber G M 
Published: March 2007

Abstract
It is generally recognized that in many patients the ureteric obstruction and other manifestations of non-malignant retroperitoneal fibrosis will respond to treatment with corticosteroids. However, most surgeons are reluctant to use steroids as the primary treatment for patients with this condition, mainly because of the risk of mismanagement of malignant retroperitoneal fibrosis. Our experience in the care of 17 patients with non-malignant retroperitoneal fibrosis has led us to believe that an initial non-surgical approach is both safe and preferable.
Augmentation of lymphokine-activated killer cell activity in patients with gastrointestinal cancer
Authors: Sedman P C , Ramsden C W , Brennan T G , Giles G R , Guillou P J 
Published: March 2007

Abstract
Adoptive cellular immunotherapy with lymphokine-(interleukin 2) activated killer (LAK) cells is not as successful in patients with gastrointestinal cancer as with other tumour types. This may be because the cytotoxic capacity of LAK cells from such patients is suboptimal. In this study we have sought to augment this activity by stimulating the lymphocytes with recombinant human interferon-γ (r-HuIFN-γ) in addition to interleukin 2 or by depleting the lymphocytes of adherent suppressive mononuclear cells. Both procedures augment LAK activity in gastrointestinal cancer patients but adherent cell depletion results in fewer cells being available for adoptive cellular immunotherapy. No further augmentation of LAK activity of adherent cell depleted cells could be accomplished by addition of r-HuIFN-γ. Co-stimulation of unfractionated peripheral lymphocytes with r-HuIFN-γ is the preferable procedure for the generation of LAK cells for adoptive cellular immunotherapy in patients suffering from gastrointestinal cancer.
Effect of LHRH agonist, Zoladex, on ovarian histology
Authors: Williamson Karen , Robertson J F R , Ellis I O , Elston C W , Nicholson R I , Blamey R W 
Published: March 2007

Abstract
In a phase 1 clinical trial Zoladex was used as first line hormonal therapy in premenopausal women with advanced breast cancer. Patients on progression of their disease underwent surgical oöphorectomy. The histology of ovaries from 23 women treated with Zoladex has been compared with the ovaries from 34 patients who, before the clinical trial of Zoladex, underwent surgical oöphorectomy as primary therapy. Both groups show similar follicular phase development. Only 13 per cent of the Zoladex group developed corpora lutea while 58 per cent showed evidence of luteinization in the primary oöphorectomy group (P &lt; 0.01). Non-neoplastic follicular cysts were seen more often in the ovaries of the Zoladex treated patients than in the primary oöphorectomy group (P &lt; 0.05). Zoladex appears to arrest not folliculogenesis but follicular maturation with inhibition of ovulation, the follicles subsequently undergoing atresia with follicular cyst formation.
Growth rate of hepatic metastases in colorectal carcinoma
Authors: Finlay I G , Meek D , Bruntont F , McArdle C S 
Published: March 2007

Abstract
The rates of growth of 29 hepatic metastases from 15 patients with primary colorectal carcinoma were studied using serial computed tomography (CT). Eleven metastases were found by the surgeon at laparotomy (overt metastases); the remaining eighteen were not evident to the surgeon at laparotomy, but were detected by CT scan during the immediate postoperative period (occult metastases). An estimate of tumour volume doubling time was obtained from a semi-logarithmic plot of tumour cell number against time. The mean doubling time for the overt metastases was 155 ± 34 days (± s.e.m.) compared with 86 y 12 days (P &lt; 0·05) for the occult metastases. The age of the metastases at the time of surgery was estimated by extrapolation of the observed growth curve assuming Gompertzian kinetics. The mean age of the overt metastases was 3·7 ± 0·9 years (±s.e.m.) The corresponding age of the occult metastases was 2·3 ± 0·4 years.
Clinicopathological assessment and staging of colorectal cancer
Authors: Williams N S , Jass J R , Hardcastle J D 
Published: March 2007

Abstract
Compared with various common neoplasms, there is no national or international agreed clinicopathological staging system for colorectal cancer. Before such a system can be developed, however, there has to be agreement on the methods used for assessment. The Colorectal Subcommittee of the United Kingdom Co-ordinating Committee on Cancer Research has, through its working party on staging, agreed various recommendations as to how the clinical and pathological assessment of patients with colorectal cancer can be standardized. By applying these standardized criteria, patients undergoing surgery can be divided into those having curative or non-curative operations, or operations which are indeterminate for cure. These recommendations represent the first step in ensuring uniformity in the classification of patients with colorectal cancer.
Effects of autologous mesothelial cell seeding on prostacyclin production within Dacron® arterial prostheses
Authors: Bull H A , Pittilot R M , Drury J , Pollock J G , Clarke J M F , Woolf N , Marston A , Machin S J 
Published: March 2007

Abstract
Canine abdominal aortas have been replaced with Dacron® arterial prostheses to assess the effects of mesothelial cell seeding on graft prostacyclin and thromboxane A2 release. At both 2 weeks and 6 weeks after surgery, three seeded and two unseeded control grafts were examined for prostacyclin release. In addition, thromboxane release was assessed in one seeded and one unseeded graft. Sections of aorta and graft were removed and incubated in PBS containing either 10 μM calcium ionophore A23187 or 20 μM arachidonic acid. The incubation mixture was sub-sampled at 5 min intervals over a 20 min period to assess the progressive release of prostacyclin and thromboxane A2 using a radioimmunoassay for 6-keto-prostaglandin F1α and thromboxane B2 respectively. In seeded grafts, 6-keto-prostaglandin F1α release averaged 15 per cent compared with aorta at 2 weeks and 45 per cent compared with aorta at 6 weeks. By contrast, release from unseeded grafts was undetectable at 2 weeks; however, by 6 weeks there was some release amounting to 15 per cent compared with aorta. There was a statistically significant increase in the release of 6-keto-prostaglandin F1α from mesothelial cell seeded grafts at 6 weeks compared with unseeded grafts (P &lt; 0·01). Thromboxane release from the graft sections was variable and unrelated to whether the grafts had been seeded or not. These preliminary results, showing that grafts seeded with autologous peritoneal mesothelial cells release more prostacyclin than unseeded grafts, further highlight the role of the mesothelial cell as an alternative to the endothelial cell for improving the patency of arterial Dacron prostheses in the early postoperative days.
Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation
Authors: Edwards J D , Redmond A D , Nightingale P , Wilkins R G 
Published: March 2007

Abstract
Oxygen consumption (Vo2) immediately following major injury in man has been said to be reduced. The evidence for this is poor. We have therefore measured Vo2 soon after major injury in 16 patients. Vo2 was reduced in only two patients, within the normal range in four and increased in ten. Vo2 was maintained by increased oxygen extraction in six patients leading to low levels of mixed venous oxygen saturation. There is no evidence for an ‘ebb phase’ response in man.
Microdochectomy for single-duct discharge from the nipple
Authors: Locker A P , Galea M H , Ellis I O , Holliday H W , Elston C W , Blamey R W 
Published: March 2007

Abstract
Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.
Breast cyst type does not predict the natural history of cyst disease or breast cancer risk
Authors: Ebbs S R , Bates T 
Published: March 2007

Abstract
The sodium (Na) and potassium (K) concentrations were measured in the fluid of 169 breast cysts aspirated from 101 consecutive patients presenting to a single clinic. The Na/K ratio was used to define cysts as either apocrine (Na/K &lt; 3) or flattened (Na/K &gt; 3) in type. There was no consistency in the type of cyst for individual patients. Cyst type was not predictive of further cyst development, neither was a particular cyst type associated with the development of, or a history of, breast cancer.