bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for large bowel neoplasms in individuals with a family history of colorectal cancer
Authors: Dunlop M G 
Published: March 2007

Abstract
Logistical problems associated with population screening for colorectal cancer are identified and the possibility of targeting screening to those with a familial predisposition to the disease is discussed. Evidence for a substantial genetic eflect on the overall incidence of colorectal cancer is reviewed. The screening detection rate of colorectal neoplasms in relatives of patients with colorectal cancer has been shown to be higher than that expected in a non-selected population; the evidence that polypectomy will reduce future colorectal cancer risk in such individuals is explored. Recent advances in the molecular genetics of colorectal cancer susceptibility are reviewed; it is possible that a genetic test might be developed in the future which could identify at least a proportion of those at risk. Excluding financial considerations, the risk-benefit ratio of colonoscopy in a screened population is intimately related to the remaining risk of colorectal cancer in those who undergo the examination. At present, patients undergoing colonoscopy to investigate a positive faecal occult blood (FOB) test as part of a population-based screening programme include individuals with a familial predisposition as well as those without. About 20 per cent of all cases of colorectal cancer are associated with an obvious genetic predisposition, and the risk of cancer in their relatives is high. Because false positives occur with Haemoccult, the residual risk to the population who are FOB positive but do not have a familial trait may be suflciently low that the dangers of colonoscopy could outweigh the potential benefits. Scotland has a high incidence of colorectal cancer, and analysis of recent Scottish incidence data shows an actuarial lifetime risk of developing this disease of one in 23 for men and one in 33 for women. As a family history of the disease increases that risk by two to four times and the neoplasms arise throughout the colon in such a group, there may be a case for oflering colonoscopy to all first-degree relatives of those under 50 years of age at diagnosis, if not of all index cases of colorectal cancer.
Prevention of venous thromboembolism after surgery: A review of enoxaparin
Authors: Bergqvist D , Lowe G D O , Berstad A , Haas S , Hirsh J , Rud Lassen M , Samama M , Verhaeghe R 
Published: March 2007

Abstract
This review discusses the problem of deep vein thrombosis (DVT) after operation and identifies three levels of risk of DVT: low (&lt; 10 per cent), moderate (10–40 per cent) and high (40–80 per cent). Special emphasis is placed on the most recent prophylactic treatment, low molecular weight heparins (LMWHs), particularly enoxaparin. Several LMWHs are now available, but they difer slightly and each must be evaluated on its own merits. In general, however, LMWHs are both efective and safe in those patients at moderate or high risk of DVT. Thromboprophylaxis is cost effective when analysed using healtheconomic methodology.
Mechanism of action of external compression on venous function
Authors: Sarin S , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
Compression stockings and bandages have been shown to improve venous haemodynamics and may act by reducing venous reflux. The aim of this study was to assess the mechanism of action of compression therapy on venous function and to determine whether such treatment may correct valvular incompetence. Both lower limbs of 36 patients (median age 59 (interquartile range 45–65) years) were assessed by duplex ultrasonographic scanning. There were 17 limbs with popliteal vein reflux, 19 with long saphenous vein (LSV) reflux and 21 with short saphenous vein (SSV) reflux. A water-filled adjustable pressure cufl was applied around the knee and inflated gradually, while continuously assessing the veins for reflux using ultrasonographic imaging. The external pressure applied by the cuff was noted when reflux was abolished or when the vein was completely occluded. In four (24 per cent) of 17 popliteal veins, eight (42 per cent) of 19 LSVs and three (14 per cent) of 21 SSVs reflux was abolished before occlusion of the vein. The cufl pressures required to achieve restoration of valvular function were significantly lower than those required to occlude the veins. It is possible, in some refluxing veins, to correct valvular dysfunction by external compression therapy. Coaptation of valvular cuffs to restore valvular competence may be the mechanism of action of compression therapy in venous disease.
Angioscope-guided neodymium yttrium–aluminium–garnet laser valvulotomy for in situ vein bypass
Authors: Pflugbeil G , Wahba A , von Sommoggy St , Dörrler J , Maurer P C 
Published: March 2007

Abstract
Valvulotomy for in situ vein bypass is commonly performed with a valvulotome. Although the procedure can be controlled through an angioscope, the dangers of intimal damage and valve remnants remain. An experimental study was designed to evaluate angioscopic laser valvulotomy compared with standard mechanical valvulotomy (n = 16). Two different laser probes, a bare 400-µm fibre (n = 20) and a 2-mm hot-tip (n = 26) were tested. Results were investigated by histology and scanning electron microscopy. Hot-tip laser valvulotomy achieved significantly better results than the 400-µm fibre. The Insitucat valvulotome yielded the worst results, with valve remnants in all cases and an 88 per cent rate of intimal damage. It is concluded that laser valvulotomy can be performed simply and safely with a very low incidence of valve remnants and intimal damage.
Infected femoral pseudoaneurysm in intravenous drug abusers
Authors: Cheng S W K , Fok M , Wong J 
Published: March 2007

Abstract
The result of surgical treatment of 21 infected femoral pseudoaneurysms in 19 intravenous drug addicts was evaluated. Eight pseudoaneurysms involved only the common or superficial femoral artery and 13 involved the femoral bifurcation. Excision and ligation was performed as the sole procedure in 19 instances, and revascularization by bypass through the obturator route was carried out in two. The mean follow-up was 12.3 months. One patient required an above-knee amputation. The resultant ischaemia was greater after triple vessel ligation (mean ankle: brachial pressure index (ABPI) 0.41) than single vessel ligation (mean ABPI 0.58). Postoperative bleeding occurred in one patient. Intermittent claudication was present in 14 patients after excision and ligation. Claudication was universal and more severe after triple than after single vessel ligation. There was no subsequent limb loss. Excision and ligation is safe and is the treatment of choice for infected femoral pseudoaneurysm in drug addicts.
Effect of aprotinin on neutrophil function after major vascular surgery
Authors: Lord R A , Roath O S , Thompson J F , Chant A D B , Francis J L 
Published: March 2007

Abstract
High-dose aprotinin reduces blood loss and blood transfusion requirements during liver transplantation and cardiac and vascular surgery. The mechanism of the haemostatic efect of aprotinin is unclear. A general effect on the anti-inflammatory response may be involved. Because leucocyte activation is part of this process, white cell function was measured in patients undergoing aortic surgery who received high-dose aprotinin therapy (n = 10) and was compared with the results from controls who did not (n = 10). The test group received an intravenous bolus (2 × 106 kallikrein inhibitor units) of aprotinin after induction of anaesthesia followed by continuous infusion (0.5 × 106 kallikrein inhibitor units/h) until the end of the operation. Blood samples were obtained before operation, immediately after surgery, and 1 and 7 days after operation. Aprotinin maintained significantly better postoperative white cell function as measured by bipolar shape formation (P &lt; 0.001), unstimulated nitroblue tetrazolium (NBT) reduction (P &lt; 0.001) and chemotaxis (P &lt; 0.001). Endotoxin-stimulated NBT reduction was similar in both groups, indicating that neutrophils from treated individuals retained the capacity to respond to oxidative stimuli. Aortic surgery activates neutrophils in vivo, as reflected by impaired chemotaxis and increased superoxide production. Aprotinin protects the cells against this potentially deleterious efect without afecting their ability to respond when provoked. Whether this afects leucocyte interaction with coagulation pathways and contributes to the reduction in blood loss remains to be determined.
Gastrointestinal tract perforation in children due to blunt abdominal trauma
Authors: Brown R A , Bass D H , Rode H , Millar A J W , Cywes S 
Published: March 2007

Abstract
Over a 14-year period 587 children under 13 years of age were admitted with blunt injury to the abdomen. Twenty-nine (4.9 per cent) of these were found to have bowel rupture. Evidence of peritonitis was present at initial evaluation in 11 children (38 per cent). Radiological evidence of perforation (pneumoperitoneum) was present in only five of 27 (19 per cent) with a further six of 27 (22 per cent) showing dilated loops of bowel or fluid levels. Thus 59 per cent of radiographs were not diagnostic. The mean time from admission to laparotomy was 17 h. Proximal bowel perforation was common and perforation at multiple sites occurred in five patients; 59 per cent had a concomitant injury which resulted in two deaths (from head injury). Initial clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeated clinical examination is advocated; progression of abdominal signs should alert the clinician to proceed to laparotomy.
Functional evaluation of the intrathoracic stomach as an oesophageal substitute
Authors: Bonavina L , Anselmino M , Ruol A , Bardini R , Borsato N , Peracchia A 
Published: March 2007

Abstract
A study of duodenogastric reflux and gastric function was undertaken in 16 patients 1–7 years after oesophagectomy and high intrathoracic oesophagogastrostomy for oesophageal carcinoma. All were able to eat satisfactorily; ten complained of mild foregut symptoms and ten had endoscopic mucosal lesions. Biliary excretion scintigraphy demonstrated pathological duodenogastric reflux in 11 patients. The emptying of a semisolid radiolabelled meal from the intrathoracic stomach in the upright position was significantly quicker than in control subjects (P &lt; 0.01). No gastric motor activity was recorded on manometry, suggesting that the transposed stomach acts like an inert tube. Results of 24-h pH monitoring showed that the area under the curve at pH &lt; 4 in the stomach was significantly less than in control subjects (P &lt; 0.0001). In addition, patients had a significantly greater oesophageal alkaline, exposure (P &lt; 0.001). The vagotomized intrathoracic stomach therefore empties well in the upright position, but is subjected to reflux of alkaline duodenal contents and can retain the ability to produce acid. The interaction between alkaline and acid contents in the pathogenesis of symptoms and mucosal lesions needs further investigation.
Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: Initial experience of a new surgical approach
Authors: Shimi S M , Nathanson L K , Cuschieri A 
Published: March 2007

Abstract
A thoracoscopic technique is described for the execution of long oesophageal myotomy for nutcracker oesophagus causing odynophagia and non-cardiac chest pain. The technique is based on a multipuncture method and a left thoracoscopic approach. It has been performed on three patients with complete symptomatic relief in the short term, although the follow-up period is short (maximum 12 months). No complications were encountered and discharge from hospital occurred by the fifth day after operation.
Early gastric cancer
Authors: Farley D R , Donohue J H , Nagorney D M , Carpenter H A , Katzmann J A , Ilstrup D M 
Published: March 2007

Abstract
Early gastric cancer comprises more than 30 per cent of gastric carcinomas treated in Japan but remains an uncommon entity in the western hemisphere. A retrospective review of 48 patients with early gastric cancer undergoing operative treatment between 1965 and 1984 was carried out. The mean patient age was 70 years, in 31 men and 17 women. Preoperative diagnosis was made in 88 per cent of patients undergoing oesophagogastroduodenoscopy with biopsy but upper gastrointestinal radiography was diagnostic in only 20 per cent. Surgical management consisted of subtotal gastrectomy (86 per cent), total gastrectomy (10 per cent) and wide local excision (4 per cent). The operative mortality and morbidity rates were 0 and 38 per cent, respectively. Mean follow-up was 7.7 years, with 44 per cent of patients still alive. Multivariate analysis disclosed only a healthy. Eastern Cooperative Oncology Group score (P = 0.002) and a diploid DNA tumour pattern (P = 0.05) as significant prognostic variables of survival. The overall survival rate of patients with early gastric cancer (70 per cent at 5 years) was equivalent to that of an age- and sex-matched control population.
Surgery in tropical pancreatitis: Analysis of risk factors
Authors: Ramesh H , Augustine P 
Published: March 2007

Abstract
Over a 7-year period, 91 patients with tropical pancreatitis underwent operation for intractable pain. Univariate and multivariate analyses were performed to identify factors correlating with mortality, major complications, poor pain relief and associated malignancy. Patients with benign disease (group 1, n = 72) had longer survival than those with superimposed malignancy (group 2, n = 19). Pain relief was better in group 1 (59 patients compared with none, P &lt; 0.01). Age above 40 years, short duration of symptoms, mass lesions on ultrasonography and main pancreatic duct obstruction on endoscopic retrograde pancreatography were associated with a high risk of cancer. After reoperation major complications (four of ten) or death (three of ten) occurred more commonly than after primary procedures (seven of 81, P = 0.019 and five of 81, P &lt; 0.05, respectively). Poor pain relief in group I patients was more common after incomplete clearance of main duct stones (four of 13 versus three of 53, P &lt; 0.01) and after short length ductotomy (three of eight versus four of 58, P &lt; 0.01). Tropical pancreatitis has a high association with pancreatic adenocarcinoma. Wide ductotomy, stone clearance and drainage gave good symptomatic results in patients with benign disease. Overall results were poor in patients with cancer.
Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: A preliminary report
Authors: Ng W D , Liu K , Wong M K , Kong C K , Lee K , Chan Y T , Leung J W C 
Published: March 2007

Abstract
An anomalous elongated pancreaticobiliary common channel encourages reflux up both the biliary tree and the pancreatic ductal system, resulting in progressive choledochal dilatation, cholangitis with ductal calculi, relapsing pancreatitis and malignant change. Transduodenal sphincteroplasty has been used to improve drainage from the abnormal channel. The use of endoscopic sphincterotomy (ES) to establish drainage and minimize the surgical risks is reported in six symptomatic patients with mild choledochal dilatation (common bile duct diameter &lt;15 mm), a common channel &lt;15mm in length and a distal stenosis. This was successful in five patients, who have no further symptoms. ES failed in the only patient with an undilated common channel and this patient went on to have open surgery. We believe ES to be safe and effective in the treatment of selected cases of long common channel.
Reduction of mucosal crypt cell proliferation in patients with colorectal adenomatous polyps by dietary calcium supplementation
Authors: Barsoum G H , Hendrickse C , Winslet M C , Youngs D , Donovan I A , Neoptolemos J P , Keighley M R B 
Published: March 2007

Abstract
The crypt cell production rate was measured in 14 patients with adenomatous colorectal polyps, 17 patients with colorectal cancer and 12 control subjects. The median (interquartile range) rate (cells per crypt per hour) was found to be significantly higher (P &lt; 0.001) in the polyp (2.45 (1.94–3.20)) and cancer (3.01 (2.35–3.68)) groups compared with controls (1.25 (0.70–1.85)). A double-blind cross-over study was performed in patients with adenomatous polyps consisting of 2 months' treatment, 2 weeks' washout, followed by 2 months' treatment with dietary calcium supplementation (1.25 g day−1) versus placebo. A significant reduction in the crypt cell production rate occurred with calcium treatment compared with the placebo (1.25 (06–2.25) versus 2.15 (1.58–3.08) cells per crypt per hour, P = 0.035). This study demonstrates a significant reduction in mucosal cell proliferation by dietary calcium supplementation in patients with adenomatous polyps. Such treatment may be worthy of further investigation in patients at high risk of developing colorectal polyps.
Improving survival rates for patients with colorectal cancer
Authors: Jatzko G , Lisborg P , Wette V 
Published: March 2007

Abstract
Between 1 January 1984 and 31 December 1990, 575 patients were operated on for colorectal cancer. The surgical procedure was performed consistently and no patients were lost to follow-up. Almost half of the patients (284 of 575) had tumours of stage I or II, with 5-year survival rates over 90 per cent. After extending the resection margins in 28 cases of colonic carcinoma there has been no case of tumour recurrence. The overall 5-year survival rate for patients with colonic carcinoma was 81 per cent. Complete resection of the mesorectum was mandatory for rectal resection. One-third of the carcinomas in the lower third of the rectum could be resected with maintenance of bowel continuity and an abdominoperineal resection avoided. Not only was the tumour recurrence rate in the former patients lower (10.5 per cent) compared with that in those undergoing abdominoperineal resection (14.3 per cent) but the 5-year survival rate at 90 versus 52 per cent was significantly higher. The overall 5-year survival rate for patients with rectal carcinoma was 71 per cent.
Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions
Authors: Sun W M , Peck R J , Shorthouse A J , Read N W 
Published: March 2007

Abstract
A combined manometric and ultrasonographic study of the internal anal sphincter was carried out in 20 patients with haemorrhoids and 20 age-matched normal controls. Mean(s.e.m.) basal anal pressure was significantly higher in patients than in controls, 62(4) versus 45(6) cmH2O (P &lt; 0.05), although there were no significant diferences in mean maximum basal and squeeze pressures. During rectal distension 90 per cent of patients showed no reduction in anal pressure in the outermost anal channel, although the internal sphincter electromyogram was suppressed and the external sphincter electromyogram did not necessarily increase above baseline. The mean(s.e.m.) maximum residual pressure was significantly higher in patients, 70(6) versus 45(6) cmH2O (P &lt; 0.05). Direct pressure measurement in anal cushions exhibited abnormally high median pressure in patients compared with controls, 35 versus 10 cmH2O (P &lt; 0.001). Pressures recorded during coughing and straining were also significantly higher in patients than in controls (P &lt; 0.001). Ultrasonographic study of the anal canal revealed a clear image of the internal sphincter, the thickness of which could easily be measured. The mean(s.e.m.) thickness of the sphincter was not significantly different, 2.3(0.2) versus 2.1(0.1) mm, between patients with haemorrhoids and controls (P = 0.18). The absence of any significant differences in the internal sphincter thickness between normal subjects and patients with haemorrhoids suggests that the high anal pressure in patients with haemorrhoids is of vascular origin.
Nutrition and malignant disease: Implications for surgical practice
Authors: Heys S D , Park K G M , Garlick P J , Eremin O 
Published: March 2007

Abstract
Malignant disease is often associated with weight loss and malnutrition. Nutritional support is frequently provided to patients with cancer in an attempt to improve nutritional status and reverse weight loss, with the aim of reducing morbidity and mortality rates. This review evaluates the effect of supplemental nutrition on morbidity and mortality in patients with malignancy undergoing treatment with surgery, chemotherapy or radiotherapy. It also assesses the effect nutritional supplementation has on host defence mechanisms and how nutrients affect tumour cell growth. The evidence suggests that perioperative nutritional support, if given for at least 10 days, reduces morbidity and mortality in patients with biochemical evidence of severe malnutrition, manifest as a low serum albumin concentration and excessive weight loss. In contrast, there is no evidence that parenteral nutritional support benefits patients undergoing chemotherapy or radiotherapy, in terms of either an increased tumour response rate or prolongation of survival. Current research on malignant disease is highlighting the role of specific nutrients (amino acids, essential fatty acids and polyribonucleotides) as key regulators of both anticancer host defence mechanisms and the control of nitrogen metabolism and tumour growth. Arginine, essential fatty acids and ribonucleotides have all been demonstrated to stimulate antitumour host defence mechanisms and some also modulate tumour cell metabolism. Dietary manipulation offers exciting possibilities for the innovative management of malignant disease.
Delayed surgery for congenital diaphragmatic hernia
Authors: Goh D W , Drake D P , Brereton R J , Kiely E M , Spitz L 
Published: March 2007

Abstract
Between January 1987 and December 1990, 67 neonates were treated for congenital diaphragmatic hernia, symptomatic within 6 h of birth. The mortality rate was 33 per cent. Preoperative stabilization was achieved in 47 patients, all of whom survived initial treatment, although two died later. Stabilization could not be achieved in 20 neonates, all of whom died within 3 days of birth, 18 without undergoing operation and two after early repair. Intensive resuscitation with controlled, delayed operation for congenital diaphragmatic hernia gives long-term results similar to those of urgent operative repair. This approach avoids operation in the majority of those who subsequently die.
Effect of biliary decompression on reticuloendothelial function in jaundiced rats
Authors: Ding J W , Andersson R , Stenram U , Lunderquist A , Bengmark S 
Published: March 2007

Abstract
The recovery of reticuloendothelial system (RES) function following decompression of obstructive jaundice was studied using a rat model with bile duct ligation and side-to-side choledochoduodenostomy. Histopathological changes in the liver were still present 5 weeks after relief of jaundice, while results of liver function tests had returned to normal. RES function evaluated by the blood clearance and organ uptake of radiolabelled Escherichia coli using a corrected phagocytic index gradually returned to normal following biliary decompression. The severely impaired RES activity noted 1 week after operation may explain the increased incidence of sepsis and renal insufficiency in the early period after biliary surgery in jaundiced patients.