bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of the delayed complications of intestinal and mesenteric injuries following experimental blunt abdominal trauma
Authors: Paterson-Brown S , Francis N , Whawell S , Cooper G J , Dudley H A F 
Published: March 2007

Abstract
Injuries to the intestine and mesentery are often found in patients undergoing laparotomy for blunt abdominal trauma. Although treatment of perforations is relatively straightforward, the same is not true for contusions. Few guidelines exist at present to aid the surgeon in deciding which injuries require resection in order to avoid the complications of delayed perforation and late stricture formation. The natural history of these non-perforating intestinal and mesenteric injuries has been examined in an experimental model to identify possible criteria on which future management can be based. In the immediate postinjury period peristalsis and local mesenteric pulsation were absent in the majority of injuries which went on to full recovery and these observations are thus of little predictive value in predicting outcome. The initial size of contusion (length of contusion along longitudinal axis of bowel) relative to bowel wall circumference (BWC) was related to complications as follows: contusion &lt; BWC (n = 47) - one complication; contusion &gt; BWC (n = 8) - three complications (P = 0·02). Similarly, six mesenteric injuries which produced an initial ischaemia (assessed by fluorescein) less than twice the BWC did not result in any complications, compared with four complications which occurred in ten cases when the initial ischaemia was greater than twice the BWC. These results go some way towards providing a better understanding of these injuries and in turn may help the emergency surgeon in deciding which injuries require resection.
Postoperative management of patients with total exocrine pancreatic insufficiency
Authors: Braga M , Zerbi A , Dal Cin S , De Franchis R , Malesci A , Di Carlo V 
Published: March 2007

Abstract
The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene®. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32·9 g/day without enzyme replacement and fell to 14·2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8·3 g/day (P &lt; 0·01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.
Outcome of surgery for non-palpable mammographic abnormalities
Authors: Aitken R J , MacDonald H L , Kirkpatrick A E , Anderson T J , Chetty U , Forrest A P M 
Published: March 2007

Abstract
Four hundred and ninety-three women underwent 515 localization biopsies for non-palpable mammographic abnormalities. The mammographic abnormality was located with a hooked wire in 509 cases. Specimen radiology was performed on all excised tissue. The mammographic abnormality was visualized in the first piece of tissue excised in 402 (78·1 per cent) cases and complete excision was achieved in 476 (92·4per cent). A palpable nodule was removed in 38 (7·4 per cent) cases and in 17 (44·7 per cent) was shown to contain a carcinoma. The mammographic abnormality was missed in 14 (2·7 per cent) cases or only partly excised in 13 (2·5 per cent). Overall 144 (28·0 per cent) localization biopsies were malignant. The mammographic abnormality was not visualized on the specimen radiograph more frequently in women aged under 55 years, in women with dense breast (Wolfe grade DM or DY) or in those whose mammographic abnormality contained only microcalcification. The 27 women in whom the mammographic abnormality was not visible on the specimen radiograph underwent repeat mammography 2 months later. Only two women required a further localization biopsy and the mammographic abnormality was recovered in the first piece of tissue excised. Women with a carcinoma underwent mastectomy or wide local excision, and residual carcinoma at the localization biopsy site was found in 64 (44·4 per cent) cases. Oestrogen receptor analysis by ligand binding assay was possible in only 71 (49·3 per cent) carcinomas. If the specimen radiograph does not show the mammographic abnormality within pieces of tissue excised and there is no palpable nodule it may be best to conclude the biopsy. In this series these missed lesions were usually benign. Only rarely is a second localization biopsy required and this is performed without difficulty.
Original communications recurrence in early gastric cancer
Authors: Ichiyoshi Yuji , Toda Tomohiro , Minamisono Yoshikazu , Nagasaki Susumu , Yakeishi Youichi , Sugimachi Keizo 
Published: March 2007

Abstract
In a retrospective study of 503 cases of early gastric cancer, 17 of the patients had died of a recurrence of the gastric cancer and 72 had died of unrelated causes. The cumulative recurrence mortality rates were 2.2% at 9 years for mucosal cancer and 8.4% at 8 years for submucosal cancer. The recurrence patterns of early gastric cancer were hematogenic metastasis to the liver, lung, or bone (nine cases), recurrence from lymph nodes (three cases), and recurrence in the residual stomach (five cases). Submucosal cancers with a macroscopically elevated appearance, lymph node metastasis, and evidence of vessel invasion were the high-risk cancers for hematogenic recurrence, and adjuvant chemotherapy should be prescribed. Two cases of lymph node recurrence were attributed to inadequacy of lymph node dissection. Because metastasis to the group 2 lymph nodes was noted in 1.5% of cases of early gastric cancer and a macroscopic diagnosis of nodal status was inaccurate, complete dissection should be performed regardless of identification of metastasis. Five cases of recurrence in the residual stomach were attributed to overlooked lesions of multiple carcinoma and were detected at an advanced stage. Careful and regular postoperative follow-up is required to detect these recurrences at an early stage. (SURGERY 1990;107:489–95).
Changing patterns of incidence and mortality from acute pancreatitis in Scotland, 1961–1985
Authors: Wilson C , Imrie C W 
Published: March 2007

Abstract
Data on all discharges from hospitals in Scotland have been recorded since 1961 as the Scottish Hospital In-Patient Statistics and examination of these data has permitted analysis of the incidence and mortality trends from acute pancreatitis. The number of discharges recorded has increased 11-fold in males from 69 patients/year in 1961 to 750 patients/year in 1985, and fourfold in females from 112 patients/year to 484 patients/year respectively. This increase has occurred particularly amongst young and middle-aged males (20–59 years) and in elderly females (over 60 years), the most marked increases occurring in the health boards of the ‘central belt’ area of Scotland. Mortality rate did not show a corresponding change, increasing only two-fold in males from 15 patients/year to 30 patients/year and in females from 29 patients/year to 37 patients/year. As a consequence the case mortality rate has fallen from 17·8 per cent over the period 1961–65 to 5·6 per cent over the period 1981–85. An apparent increase in the incidence of acute pancreatitis may be inferred from these data, much of which is thought to be due to improved accuracy in diagnosis.
Management of the Mirizzi syndrome and the surgical implications of cholecystcholedochal fistula
Authors: Baer H U , Matthews J B , Schweizer W P , Gertsch P , Blumgart L H 
Published: March 2007

Abstract
Several methods of handling the residual choledochal defects encountered during operation for type II Mirizzi syndrome have been described. Early experience with eight patients treated by a variety of procedures including direct suture and flap techniques led to disappointingly high morbidity and mortality rates. Since 1986 a standardized surgical approach has been used in four patients without complications or mortality. Essential to management are preoperative diagnosis by ultrasonography and endoscopic retrograde cholangiopancreatography and classification of the Mirizzi syndrome into two types as proposed by McSherry. Mirizzi type I consists of an extrinsic compression of the hepatic duct by a calculus impacted in the cystic duct or in Hartmann's pouch. This is treated by cholecystectomy with or without common bile duct exploration. In the more difficult Mirizzi type II, the stone has eroded into the hepatic duct causing a cholecystcholedochal fistula. This is treated by partial cholecystectomy and a cholecystcholedochoduodenostomy. This management strategy prevents inadvertent bile duct injury and has yielded satisfactory results.
Choice of incision and pain following gallbladder surgery
Authors: Armstrong P J , Burgess R W , Macgowan W A L 
Published: March 2007

Abstract
A prospective randomized trial compared pain in the first 24 h after gallbladder surgery via an upper midline or a transverse incision. Pain was measured by the patients' self-administered consumption of pethidine, degree of postoperative respiratory impairment and a visual analogue pain scale. The upper midline incision group self-administered significantly more pethidine than the transverse incision group (P&lt;0–001), but there was no difference between the groups in respiratory function or visual analogue pain scale results 24 h after operation. Length of hospital stay was not different. An upper midline incision is more painful than a transverse incision in the first 24 h following gallbladder surgery.
Truncoumbilical bypass of the portal vein in radical resection of biliary tract tumour involving the hepatic duct confluence
Authors: Kumada K , Ozawa K , Shimahara Y , Morikawa S , Okamoto R , Moriyasu F 
Published: March 2007

Abstract
Before combined resection of the right hepatic lobe and the hepatoduodenal ligament, an autogenous external iliac vein was interposed between the root of the portal vein trunk and the umbilical portion of the vein in four patients with biliary tract tumour. The left hepatic arterial pathway was preserved, except in one case in whom resection of this artery was followed by reconstruction. This procedure allowed successful and safe extended right hepatic lobe resection and combined en bloc resection of the hepatoduodenal ligament while preserving hepatic blood perfusion.
Reduced water and sodium intakes associated with high levels of natriuretic factor following common bile duct ligation in the rabbit
Authors: Oms L , Martínez-Ródenas F , Valverde J , Jiménez W , Sitges-Serra A 
Published: March 2007

Abstract
Renal failure complicating obstructive jaundice (OJ) is probably linked to reduction of the extracellular water compartment. To elucidate the mechanism by which OJ leads to isotonic water depletion we studied a group of rabbits with OJ after common bile duct ligation (n = 17) and another group of sham operated rabbits (n = 14) for 10 days. Water intake and balance for two study periods (1–4 and 7–10 days after operation) were calculated. Renal function, sodium balance and plasma atrial natriuretic factor were determined on the fourth and tenth days after operation. Water intake and balance were lower in the OJ group both in the first study period (230 versus 519 ml/days 1–4, P&lt;0–001; and—2·4 versus 279 ml/days 1–4, P &lt; 0·0001 respectively) and in the second study period (260 versus 865 ml/days 7–10, P&lt; 0·0001; and 11 versus 379 ml/days 7–10, P&lt; 0·000 7 respectively). Sodium intake was negligible in the OJ group both on day four (0·73 versus 7·75 mM/24 h, P&lt;0·0001) and on day 10 (0·78 versus 15·78 mM/24 h, P&lt;0·0001). As a result plasma osmolality did not change. Day 10 urine osmolality and osmolar clearance were reduced in the OJ group (653 versus 1103 mOsm/kg, P&lt;0·0001 and 0·09 versus 0·25 ml/min, P&lt;0·0001 respectively) together with a decreased creatinine clearance (3 versus 77 ml/min, P&lt;0·0001). Atrial natriuretic factor was increased in jaundiced rabbits (day 4, 22·7 versus 7·5 fmol/ml, P&lt;0·0001; and day 10, 26·5 versus 11·2 fmol/ml, P&lt;0·02). These findings suggest that OJ leads to an isotonic volume depletion resulting from abnormalities of the extracellular volume regulating mechanisms. These appear to be secondary to an inappropriate elevation of the atrial natriuretic factor plasma concentration.
Effect of defunction on cytokinetics and cancer at colonic suture lines
Authors: Appleton G V N , Davies P W , Williamson R C N 
Published: March 2007

Abstract
An intestinal suture line potentiates experimental carcinogenesis in its vicinity, probably due to adaptive hyperplasia. By contrast, a defunctioning colostomy causes distal hypoplasia, and fewer tumours develop. Male Sprague-Dawley rats (n = 160) were used to study adaptation (assessed by a stathmokinetic technique) and carcinogenesis (induced by azoxymethane) at an end-to-end anastomosis that was raised in either functioning or defunctioned left colon. Controls had no procedure and other rats had proximal colostomy alone. Defunction had a profound antitropic effect on the colon, reducing bowel length and weight and crypt cell production rate (CCPR) by 22–56 per cent. Anastomotic CCPR was increased by a factor of 2–6 over controls: mean(s.e.m.) values of 12·71(2–85) versus 4·87(0·41) cells/crypt/h (P&lt;0·01), but defunction reduced this by 76per cent to a mean(s.e.m.) value of 3·00(0·52) cells/crypt/h below that in the intact colon. In the left colon, 39–50 per cent of tumours were sited at the anastomosis. Compared with controls there were 77 per cent fewer tumours in defunctioned colon, but they still favoured the site of anastomosis. Neoplasms at the colostomy site accounted for 74–77 per cent of all right-sided tumours. Anastomosis and defunction have powerful but contrasting effects on colonic adaptation and carcinogenesis; when combined they tend to cancel each other out.
Constipation: Another indication for restorative proctocolectomy
Authors: Hosie K B , Kmiot W A , Keighley M R B 
Published: March 2007

AbstractWe have extended our experience of restorative proctocolectomy and ileoanal anastomosis to include 13 patients with functional bowel disorders. Eight had recurrent constipation after colectomy for slow transit constipation and five had constipation and overflow incontinence associated with megarectum and megacolon. In all cases the only alternative was a permanent stoma. Despite a high complication rate, 11 patients (85 per cent) felt that the operation had been worthwhile with improvement of their symptoms and quality of life. The operation led to a mean frequency of defaecation of 4·8 times (range 2–8) during the day, and 1·2 times (range 0–4) during the night. There was no frank incontinence and, while only one patient experienced soiling during the day, six patients suffered from night-time soiling. Two patients have had the pouch converted to an ileostomy due to persistent complications and a poor functional result.
Coeliac artery compression syndrome: The effect of decompression
Authors: Geelkerken R H , van Bockel J H , De Roos W K , Hermans J 
Published: March 2007

Abstract
The effects of operation to decompress the coeliac artery were evaluated in 11 consecutive patients with coeliac artery compression syndrome. Immediately after the operation all patients were free of symptoms. Three months later three of the 11 had recurrent abdominal pain. Long-term follow-up between 15 and 23 years, obtained by questionnaire, was available for eight patients. All eight had return of symptoms similar to those before surgery. These unsatisfactory results suggest that operation should not be undertaken in patients with vague upper abdominal complaints and compression of the coeliac artery by the median arcuate ligament, who do not otherwise have pathological conditions which might explain their symptoms.
The role of interventional radiology for complications of cholecystectomy
Authors: van Sonnenberg Eric , Casola Giovanna , Wittich Gerhard R , Christensen Ross , Varney Robert R , Neff Courtney C , D'Agostino Horacio B , Moossa A R 
Published: March 2007

Abstract
This report summarizes diagnostic and therapeutic radiologic procedures in 45 patients who suffered major complications from cholecystectomy. Complications were divided into (1) bile duct injury or ligation and (2) a variety of pathologic fluid collections. Specific lesions were bile duct injury (n = 6), accidental bile duct ligation (n = 12), ductal stricture (n = 12), abscess (n = 11), biloma (n = 7), hematoma (n = 5), infected pancreatic pseudocyst (n = 3), and stones (n = 2). Presenting problems were sepsis, jaundice, and intermittent cholangitis. The patients underwent 104 interventional radiologic procedures including 29 percutaneous transhepatic cholangiograms, 21 percutaneous biliary drainages, 12 balloon dilatations of strictures, drainage of 11 abscesses, 8 bilomas, 5 hematomas, and 3 pancreatic pseudocysts. Stones were removed by baskets in 2 patients; 12 pressure and perfusion studies were performed. One hundred of 104 procedures were successful; there was one failed biliary drainage, one unsuccessful stricture dilatation, one unsuccessful hematoma drainage, and one recurrent biloma. Thirty patients were spared another operation. The percutaneous procedures were beneficial although not curative in 14 of 15 patients who underwent reoperation; in those patients the procedures helped to establish a diagnosis, improve the patient's preoperative status, or serve as a landmark for the surgeon to locate and repair the ligated or injured duct. One patient died after reoperation, a 2.2% mortality rate. Sectional imaging studies combined with interventional radiologic procedures help to diagnose promptly and effectively treat major complications of cholecystectomy. These interventional procedures either cure the complication and obviate reoperation or aid the surgeon by relieving sepsis and jaundice before reoperation and providing an intraoperative guide for bile duct reconstruction. (SURGERY 1990;W7:632–8.)
Percutaneous endoscopic gastrostomy
Authors: Moran B J , Taylor M B , Johnson C D 
Published: March 2007

Abstract
The many variations of surgical gastrostomy for nutritional support or for long-term gastric decompression all have a significant morbidity and mortality. An ‘incisionless’ technique under local anaesthesia, namely percutaneous endoscopic gastrostomy, was described in 1980. A review of the literature shows that the percutaneous technique is safer for the patient, easier and faster to perform and considerably cheaper than surgical gastrostomy. As the few complications usually require surgical management, percutaneous endoscopic gastrostomy should be considered a surgical technique. Few patients are unsuitable for the percutaneous endoscopic technique and this route should be considered for all patients referred for a gastrostomy.
Surgical management of anorectal disease in HIV-positive homosexuals
Authors: Miles A J G , Mellor C H , Gazzard B , Allen-Mersh T G , Wastell C 
Published: March 2007

Abstract
One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5·9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17·5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.
Mutagenicity of bile and duodenal adenomas in familial adenomatous polyposis
Authors: Spigelman A D , Crofton-Sleigh C , Venitt S , Phillips R K S 
Published: March 2007

Abstract
Duodenal adenomas occur almost inevitably in patients with familial adenomatous polyposis (FAP) whereas gastric adenomas are rare. FAP patients are also at high risk of duodenal cancer. Within the duodenum, adenomas cluster around the ampulla of Vater, as do the majority of duodenal cancers, suggesting that bile plays a role in tumour development. We therefore tested duodenal bile from 29 postcolectomy FAP patients (27 of whom had duodenal adenomas) and 24 non-FAP patients for mutagenicity, using techniques that detect point mutations in bacteria. Results which appeared to show that FAP bile was more mutagenic than control bile could be accounted for by a feeding effect, elimination of which also eliminated ‘mutagenicity’. Under the conditions of our assays we conclude that if bile is an important factor in genesis of duodenal tumours, it does not act by inducing point mutation.
Fistulotomy without external sphincter division for high anal fistulae
Authors: Kennedy H L , Zegarra J P 
Published: March 2007

Abstract
Thirty-two patients with high trans-sphincteric or suprasphincteric fistulae underwent fistulotomy without external sphincter division. Fifteen patients had posterior fistulae involving the deep postanal space and 17 patients had anterior fistulae. Primary healing, after removal of the seton, occurred in 25 of the 32 patients (78 per cent). Primary healing in patients with posterior fistulae occurred in 66 per cent and in 88 per cent of patients with anterior fistulae. Following surgery, eight patients (33 per cent) reported problems controlling flatus, six patients (25 per cent) reported mucous discharge and one patient (4 per cent) complained of occasional incontinence for liquid stool. No patient experienced problems controlling solid stool nor did any patient require the use of a protective pad. These results have encouraged us to use this method as the initial procedure of choice for these more difficult fistulae. A significant number of patients can be cured of their fistula while preserving the external sphincter, thereby minimizing the impact of surgical therapy on continence.
Penetrating visceral injuries of the neck: Results of a conservative management policy
Authors: Ngakane H , Muckart D J J , Luvuno F M 
Published: March 2007

Abstract
A study of the conservative treatment of 109 patients with penetrating neck injuries was carried out over 3 years. Patients with clinical or radiological evidence of injury to the oesophagus or trachea were included in the study while nine patients with major vascular trauma were explored immediately and excluded. Three late vascular operations were performed. The remaining 106 patients were treated conservatively. There were two deaths, both from associated injuries. The remaining 104 patients were treated successfully with only three cases of minor wound sepsis. We conclude that oesophageal and tracheal injuries after stab injuries and low velocity gunshot wounds can be treated successfully by non-operative treatment.