bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic resection for metastatic tumours from gastric cancer: Analysis of prognostic factors
Authors: Ochiai T , Sasako M , Mizuno S , Kinoshita T , Takayama T , Kosuge T , Yamazaki S , Maruyama K 
Published: March 2007

Abstract
Determinants of prognosis after hepatic resection for metastasis from gastric cancer were studied in a retrospective series of 21 patients, including four who survived more than 5 years after surgery. All patients underwent apparently curative resection. Synchronous or metachronous resection, age, sex, histological type, depth of invasion, lymphatic and venous invasion, lymph node involvement and number of hepatic metastases were analysed as prognostic factors for survival. Serosal invasion was the only significant determinant at synchronous resection. Both lymphatic and venous invasion were significant prognostic factors available after histological examination. Combined analysis of these two histological variables revealed that patients positive for both were at a significantly higher risk for both overall and disease-free survival. It is suggested that hepatic resection should be attempted in patients with synchronous or metachronous metastases if there is no serosal invasion by the primary gastric tumour, and if the primary tumour has neither venous nor lymphatic invasion in the case of metachronous metastases.
Combined resection of the pancreas and portal vein for pancreatic cancer
Authors: Takahashi S , Ogata Y , Tsuzuki T 
Published: March 2007

Abstract
Between March 1976 and December 1992, 137 (57 per cent) of 239 patients with pancreatic duct cell cancer underwent resection; 79 (58 per cent) of the 137 had combined resection of the pancreas and portal vein. Sixty-three of the 79 patients underwent resection of the portal vein alone; six died (mortality rate 10 per cent). The mortality rate was the same as that in 58 patients with no resection of the portal vein. In the remaining 16 patients adjacent arteries were also resected, with seven deaths. Of patients with resection of the portal vein alone who underwent curative resection, four survived more than 5 years, accounting for nearly half of the nine 5-year survivors. Combined resection of the pancreas and portal vein is associated with both an increased resectability rate and improved long-term survival.
Laparoscopic ultrasonography in the evaluation of the biliary tree during laparoscopic cholecystectomy
Authors: Greig J D , John T G , Mahadaven M , Garden O J 
Published: March 2007

Abstract
A prospective comparative study to evaluate operative cholangiography and laparoscopic ultrasonography in the detection of common bile duct (CBD) stones was undertaken in 54 patients undergoing laparoscopic cholecystectomy. Laparoscopic ultrasonography with a 7·5-MHz linear-array probe was performed before gallbladder mobilization. The incidence of choledocholithiasis at operation was 13 per cent (seven patients). Cholangiograms were not obtained in six patients, one of whom had common duct stones identified by laparoscopic ultrasonography. Operative cholangiography detected five of the remaining six CBD stones with two false-positive examinations. Laparoscopic ultrasonography detected five of the seven stones with two false-positive examinations. The finding of a CBD diameter of 7 mm or greater and gallbladder stones of up to 3 mm in diameter by laparoscopic ultrasonography would have identified all patients with common duct stones and implies that none of these would have undergone false duct exploration. Laparoscopic ultrasonography is useful in the detection of choledocholithiasis.
Lipid peroxidation and prostaglandins in colorectal cancer
Authors: Hendrickse C W , Kelly R W , Radley S , Donovan I A , Keighley M R B , Neoptolemos J P 
Published: March 2007

Abstract
Dietary fat, arachidonic acid metabolism and lipid peroxidation have all been implicated in colorectal carcinogenesis. Fatty acids, prostaglandins (PGE2, PGF2α) and malondialdehyde (MDA), the stable end-product of lipid peroxidation of polyunsaturated fatty acids (PUFAs), were studied in paired tumour and normal mucosa of 20 patients with colorectal cancer. Levels of arachidonic acid and total PUFAs were increased in the phospholipid fraction of tumours (P &lt; 0·05). Levels of PGE2 and MDA were also higher in tumours (P &lt; 0·001) and there was a significant correlation between MDA and PGE2 concentrations (rs = 0·69, P &lt; 0·01). In contrast to previously reported in vitro studies, this work suggests that lipid peroxidation may be enhanced in human colorectal tumours. As PGE2 and MDA have been shown to be involved in carcinogenesis, these may be considered potential therapeutic targets for preventing or treating colorectal carcinoma.
Malignant obstruction of the left colon
Authors: Deans G T , Krukowski Z H , Irwin S T 
Published: March 2007

Abstract
The management of malignant obstruction of the colon distal to the splenic flexure is controversial. The ‘traditional’ three-stage procedure is marred by frequent failure to complete the planned sequence of operations and a resulting high permanent stoma rate. At each stage the mortality rate (7 per cent) and morbidity rate (30 per cent) are significant. The mortality rate following primary resection with delayed anastomosis (Hartmann's procedure) is 10 per cent. However, many patients experience complications and only 60 per cent have the stoma reversed. Primary anastomosis may be performed after subtotal or segmental colonic resection. The reported mortality rate is about 10 per cent with anastomotic leakage in 4–6 per cent, but cases are often carefully selected. It is difficult to suggest clear guidelines based on existing data. Although there are strong arguments in favour of a single-stage procedure, surgeons must decide whether available resources and local circumstances permit this. The alternative is Hartmann's procedure or referral to a surgeon with an interest in emergency colorectal surgery.
Somatostatin receptor-dependent growth inhibition of liver metastases by octreotide
Authors: van Eijck C H J , Slooter G D , Hofland L J , Kort W , Jeekel J , Lamberts S W J , Marquet R L 
Published: March 2007

Abstract
Rats were administered the somatostatin analogue octreotide 15 μg intraperitoneally twice daily for 4 weeks after intraportal injection of somatostatin receptor-positive pancreatic tumour cells (CA-20948) and somatostatin receptor-negative colonic tumour cells (CC531). Octreotide significantly inhibited the growth and development of somatostatin receptor-positive tumour cells in the liver. The median number of liver tumours was 286 (range 146 to greater than 500) in the treated animals and more than 500 (range 250 to in excess of 500) in the controls (P&lt;0·05). This significant difference in tumour load was also represented in the mean(s.e.m.) liver weight (14·5(3·7) g in animals given octreotide versus 17·9(3·0) g in the controls). No effect of octreotide treatment was found on the growth and development of somatostatin receptor-negative tumour cells in the liver. The median (range) number of tumours was 6·5 (0–425) in the treated animals and 11·0 (0–475) in the controls. Mean(s.e.m.) liver weights were 14·0(5·7) g and 11·8(4·5) g respectively. There was no difference in serum levels of growth hormone, prolactin and insulin-like growth factor between control and octreotide-treated rats. The growth inhibition of somatostatin receptor-positive tumour cells was unlikely to be the result of suppressed secretion of one of these tumour growth factors. Octreotide may be useful for the treatment of patients with somatostatin receptor-positive hepatic metastases, which can be demonstrated by somatostatin receptor scintigraphy.
Influence of viral hepatitis status on operative morbidity and mortality in patients with primary hepatocellular carcinoma
Authors: Higashi H , Matsumata T , Adachi E , Taketomi A , Kashiwagi S , Sugimachi K 
Published: March 2007

Abstract
The influence of associated viral hepatitis status on 119 patients with primary hepatocellular carcinoma (HCC) undergoing hepatic resection was investigated. Operative morbidity and mortality were examined in three patient groups: 31 patients (group B) positive for hepatitis B surface antigen (HBsAg), 14 (group Be) positive for both HBsAg and hepatitis B e antigen, and 74 (group C) positive for hepatitis C virus antibody (HCVAb). Preoperative liver function in groups Be and C was similar and more impaired than that of patients in group B; combined active hepatitis was seen most frequently in group C (68 per cent). The tumour size in group B was significantly greater than that in groups Be and C. Postoperative complications occurred more frequently in group C (39 per cent) and early postoperative deaths, other than those from cancer, were seen in nine patients positive for HCVAb, of whom three developed postoperative liver failure. Patients with HCC and hepatitis B without seroconversion as well as hepatitis C frequently have active hepatitis, which may impair liver function and play an important role in operative morbidity and mortality.
Prevention of hepatitis B infection: A survey of surgeons and interventional cardiologists
Authors: Caruana-Dingli G , Berridge D C , Chamberlain J , Gould K , Harrison J 
Published: March 2007

Abstract
Hepatitis B immunization and the use of protective measures against blood contamination were assessed in a group of clinicians associated with invasive procedures. A self-administered confidential questionnaire was sent to 140 surgeons and interventional cardiologists, of whom 105 (75 per cent) replied. Ninety-five respondents (90 per cent) were immunized against hepatitis B, most (63 per cent) by an occupational health department and the majority within 5 years of this study. Only 80 per cent had had their immunity tested after immunization. Barrier protective techniques were used infrequently, with 30 per cent of respondents wearing impermeable gowns, 14 per cent wearing visors and 9 per cent using double-gloving for all procedures. Department of Health guidelines on protection from hepatitis B were published after this survey and the implementation of these guidelines in an NHS trust hospital is discussed.
Long-term pain: Less common after laparoscopic than open cholecystectomy
Authors: Stiff G , Rhodes M , Kelly A , Telford K , Armstrong C P , Rees B I 
Published: March 2007

Abstract
Persistent symptoms after cholecystectomy are common, occurring in up to 40 per cent of patients. Severe pain persists in 10 per cent of cases. A total of 450 patients were studied, 200 after open cholecystectomy and 250 after the laparoscopic operation. Patient notes were reviewed and a postal questionnaire was circulated. Responses were obtained from 155 patients (77·5 per cent) undergoing opencholecystectomy and 205 (82·0 per cent) having the laparoscopic operation. Mean(s.d.) follow-up was 32(23) months after open cholecystectomy and 15(7) months after the laparoscopic procedure. Right upper quadrant pain was more common after open cholecystectomy (9·7 versus 3·4 per cent, P &lt; 0·05). Indigestion and heartburn were equally prevalent in the two groups. Some 59·4 per cent of patients were free from symptoms after open cholecystectomy compared with 63·4 per cent following the laparoscopic operation; there was symptomatic improvement in 30·3 and 31·7 per cent respectively. Symptoms were the same or worse in 10·3 per cent of patients after open cholecystectomy compared with 4·9 per cent after the laparoscopic operation (P &lt; 0·05). Patients report significantly less right upper quadrant pain after laparoscopic than after open cholecystectomy.
Pouch–vaginal fistula after restorative proctocolectomy: Aetiology and management
Authors: O'Kelly T J , Merrett M , Mortensen N J , Dehn T C B , Kettlewell M 
Published: March 2007

Abstract
Pouch-vaginal fistula is a rare complication following restorative proctocolectomy. Seven patients who developed such a fistula are presented. Six pouch-vaginal fistulas occurred at the level of the pouch-anal anastomosis and one 3 cm above the anastomosis, level with the posterior vaginal fornix. The anastomosis had been hand-sewn in four patients (following mucosectomy) and stapled in three. Five fistulas presented within the perioperative period (median 16 (range 10–30) days) and two at 186 and 273 days. Treatment was successful in the patients who presented early, and these remain continent with functioning pouches. If not already present (two patients), an ileostomy was raised. Repair was by endovaginal flap advancement, combined with fistulotomy and sphincter repair in two patients. Treatment was unsuccessful in the two patients who presented late; in both the diagnosis was revised to Crohn's disease, necessitating pouch excision.
Factors affecting continence after surgery for anal fistula
Authors: Lunniss P J , Kamm M A , Phillips R K S 
Published: March 2007

Abstract
Anorectal physiology and continence were assessed prospectively before and after surgery in 50 patients with chronic perianal sepsis. Functional and physiological parameters were unchanged after surgery in 13 control patients who had sepsis but who did not undergo division of the anal sphincter. Group 1 comprised 22 patients with internal sphincter division alone (15 intersphincteric, seven trans-sphincteric treated by a loose seton technique) and group 2 consisted of 15 patients with a trans-sphincteric fistula laid completely open. In group 1 the median (interquartile range (i.q.r.)) resting pressure in the distal 1 cm of the anal canal was reduced from 68 (60–90) cmH2O before surgery to 44(35–60) cmH2O after operation (P&lt;0·001); squeeze pressure was less affected, but function deteriorated in 11 of the 22 patients. The median (i.q.r.) resting pressure in group 2 patients also fell, from 68(34–84) cmH2O before operation to 28 (20–54) cmH2O afterwards (P = 0·003); median (i.q.r.) maximum squeeze pressure decreased more, from 124(76–170) cmH2O to 72 (48–112) cmH2O (P=0·002). Functional deficit occurred in eight of the 15 patients. Incontinence was related to low resting pressure, reflecting internal sphincter integrity, and to local epithelial electrosensitivity (reflecting scarring), but not to squeeze pressure, fistula type or surgical treatment.
Effect of an endovascular stent on healing of an end-to-end polytetrafluoroethylene–artery anastomosis in a canine model
Authors: Chalmers R T A , Hoballah J J , Sharp W J , Kresowik T F , Corson J D 
Published: March 2007

Abstract
A canine model of end-to-end anastomosis between the iliac arteries and polytetrafluoroethylene grafts was developed; a self-expanding Wallstent was placed across one anastomosis. The opposite limb acted as a control. Animals were killed at 4 or 12 weeks. Sections were taken and the intimal thickness and luminal area calculated. At 12 weeks intimal thickness was significantly greater at anastomoses in control sections (P = 0·007), and at the interface between the proximal stent and graft in stented graft limbs (P = 0·01). Control graft limbs had significantly enhanced intimal thickness at the anastomotic level at 12 weeks compared with that at 4 weeks (P = 0·0002), while there was no such increase for the stented side. There was no significant difference in luminal area between control and stented graft limbs. Anastomotic neointimal hyperplasia in a canine graft-artery bypass model is modified by endovascular stenting.
Bradykinin, coronary artery disease and gastro-oesophageal reflux
Authors: Caldwell M T P , Byrne P J , Marks P , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
Gastro-oesophageal reflux and coronary artery disease frequently coexist. Stimulation of myocardial vagal receptors impairs lower oesophageal sphincter (LOS) function and may explain this link. This study examined the role of bradykinin, produced in increased quantities by the ischaemic myocardium, in activating this reflex. Thirteen dogs had patches soaked in bradykinin 100 μg/ml and saline applied sequentially to the left ventricular epicardium. Eleven of these animals were further divided into two subgroups: group 1 animals (six dogs) had the above sequence repeated after obliteration of sympathetic afferent fibres with phenol and those in group 2 (five animals) underwent sequential intravenous and intra-atrial injection of bradykinin 0·2 μg/kg. Epicardial bradykinin produced a fall in mean(s.e.m.) LOS tone from 13·3(1·3) to 6·0(0·5) sphinctometer units (P&lt; 0·002), accompanied by a reduction in mean(s.e.m.) arterial pressure from 95(4) to 83(5) mmHg (P&lt; 0·002). Destruction of sympathetic afferent fibres did not alter the LOS effect. Intra-atrial, but not intravenous, bradykinin reproduced the LOS effect. this suggests a cardiac origin. Myocardial release of bradykinin may play a role in producing transient LOS relaxation, predisposing to gastro-oesophageal reflux.
Survival after peranal and abdominoperineal resection for rectal carcinoma
Authors: Savage A P , Reece-Smith H , Faber R G 
Published: March 2007

Abstract
The outcome of a consecutive series of 47 patients with rectal cancer treated by endoscopic transanal resection or peranal local excision was contrasted with that of 42 patients undergoing abdominoperineal resection. Surgery was considered curative for 35 and nine patients treated by abdominoperineal and peranal resection respectively (P &lt; 0·001). Patients undergoing peranal excision were older than those treated by abdominoperineal resection (median 77 versus 69 years, P &lt; 0·01). The 5-year survival rate of patients undergoing peranal resection was 24 per cent compared with 33 per cent for those treated by the abdommoperineal procedure (P &lt; 0·005). When surgery was palliative the survival rate after both procedures was the same. Survival after peranal excision was significantly poorer than that after abdominoperineal resection but this may be acceptable when the stage of disease and age of the patients are taken into account.
Antegrade enemas for the treatment of severe idiopathic constipation
Authors: Hill J , Stott S , MacLennan I 
Published: March 2007

Abstract
The technique of appendicocaecostomy produces a continent catheterizable channel through which colonic washouts are given. This procedure was performed on six women of mean age 33·5 years with severe idiopathic constipation (mean stool frequency less than 1 per week) resistant to medical therapy. All patients had prolonged colonic transit times, three had evidence of obstructed defaecation and all had reduced or absent voluntary anal squeeze pressure. Patients found the appendicocaecostomy and catheterization acceptable, and symptoms of abdominal distension and pain resolved. All patients were able to initiate defaecation and evacuate the colon within 1h of irrigation, and no patient had appreciable incontinence. Irrigation was necessary every 48–72h. Adults with intractable constipation and pelvic floor weakness would be at risk of faecal incontinence after ileorectal anastomosis; it is in these patients that appendicocaecostomy has potential for the greatest benefit.
Comparative audit of colorectal resection with the POSSUM scoring system
Authors: Sagar P M , Hartley M N , Mancey-Jones B , Sedman P C , May J , Macfie J 
Published: March 2007

Abstract
Comparison of outcome after colorectal resection between different surgical units is difficult. Crude rates of morbidity and mortality may give a distorted picture as such rates fail to account for variations in case mix and physiological status of patients. The simple and validated scoring system POSSUM (Physiological and Operative Severity Score for en Umeration of Mortality and morbidity) was used to compare outcome after colorectal resection in two units. Consecutive series of patients who underwent colorectal resection in unit 1 (a university teaching hospital) or unit 2 (a district general hospital) were scored with the POSSUM system. Postoperative complications and 30-day mortality were recorded. In unit 1, 66 patients underwent colorectal resection with a mortality rate of 6 per cent and a morbidity rate of 9 per cent. In unit 2 the rates of mortality and morbidity were 9 and 26 per cent respectively for 182 patients undergoing colorectal resection. However, application of POSSUM predicted a mortality rate of 5·2 per cent for patients in unit 1 and 9·8 per cent for those in unit 2 with predicted morbidity rates of 11·2 and 23·9 per cent respectively. Direct comparison of outcome between these two units would be misleading. Application of POSSUM allows more realistic comparative audit of colorectal resection.
Role of lipid mediators in the pathogenesis of skeletal muscle infarction and oedema during reperfusion after ischaemia
Authors: Homer-Vanniasinkam S , Gough M J 
Published: March 2007

Abstract
During revascularization of skeletal muscle lipid mediators are released that may have a role in the pathogenesis of reperfusion injury. This study investigated the efficacy of the lipid mediator antagonists U74500A (a lipid peroxidation inhibitor), GR32191 (a thromboxane A2 receptor antagonist) and SC41930 (a leukotriene B4 (LTB4) receptor antagonist) in altering muscle viability and oedema, in a rat hindlimb model of 6-h ischaemia and 4-h reperfusion. Study groups comprised normal, ischaemic (6-h ischaemia) and control rats, and animals receiving the lipid mediator antagonists. Ischaemia itself did not result in muscle oedema or necrosis but both occurred following reperfusion (P&lt;0·01). Muscle viability was preserved by all lipid mediator antagonists (P&lt;0·01 versus controls, P not significant versus normal and ischaemia), with the LTB4 receptor antagonist ameliorating limb oedema (P&lt;0·01 versus controls). These results demonstrate a role for lipid mediators in reperfusion injury and suggest that their antagonists might aid the management of acute limb ischaemia.
Experience with brain biopsy in acquired immune deficiency syndrome-related focal lesions of the central nervous system
Authors: Iacoangeli M , Roselli R , Antinori A , Ammassari A , Murri R , Pompucci A , Scerrati M 
Published: March 2007

Abstract
Involvement of the central nervous system (CNS) in patients with acquired immune deficiency syndrome (AIDS) is an increasing clinical problem. The most common brain complications are toxoplasmosis (50–70 per cent), primary CNS lymphoma (20–30 per cent) and progressive multifocal leucoencephalopathy (10–20 per cent). Almost two-thirds of these conditions can be treated, early diagnosis and therapy leading to survival with a good quality of life. Although clinical and neuroradiological criteria alone may have high predictive value, they are not sufficient to distinguish the broad spectrum of diseases reliably. Consequently, biopsy appears necessary for definite diagnosis in some cases. The potential role and timing of brain biopsy have been assessed. Twenty-four of 50 human immunodeficiency virus-seropositive patients with focal cerebral lesions were considered for biopsy between October 1991 and December 1992. Twelve underwent brain biopsy, seven stereotactic and five ultrasonographically guided. A diagnosis was achieved in 11 patients: six primary lymphoma, three progressive multifocal leucoencephalopathy, and one mycotic and one tuberculous abscess. Both techniques proved to be safe and reliable, with a 92 per cent diagnostic rate. These data confirm the usefulness of biopsy in patients with AIDS with its wide range of associated cerebral lesions that require different aggressive treatments. On the basis of this preliminary experience and reports in the literature, it is considered that brain biopsy is indicated for patients with focal enhancing cerebral mass lesions seen on computed tomography and magnetic resonance imaging who do not respond to an appropriate trial of empirical antitoxoplasmosis therapy and for those showing rapid clinical deterioration in whom imaging and serology do not suggest toxoplasmosis.