bluuebunny/crossref_metadata_2025_split huggingface dataset:
Graves' ophthalmopathy after subtotal thyroidectomy and radioiodine therapy
Authors: Fernández Śnchez J R , Pradas J Rosell , Martinez O Carazo , Vela E Torres , Jimenez F Escobar , Fuentes I Garbin , Thorbeck R Vara 
Published: March 2007

Abstract
Forty-five patients with Graves' ophthalmopathy were studied prospectively. Twenty-one patients (42 orbits; group 1) were treated surgically by subtotal thyroidectomy and 24 (48 orbits; group 2) received radioiodine therapy. All patients underwent tests of thyroid function, ophthalmological examination, and axial and coronal computed tomography before and 12 months after treatment. Patients in group 1 showed significant improvement in the Feldon score (P &lt; 0·001), in proptosis as estimated by Hertel exophthalmometry (P &lt; 0·001) and in proptosis (P &lt; 0·001), maximum diameter of the medial rectus (P &lt; 0·01), lateral rectus (P &lt; 0·05), superior group (P &lt; 0·05) and inferior rectus (P &lt; 0·001) muscles as estimated by computed tomography. Patients in group 2 showed significant improvement only in the Feldon score (P &lt; 0·05). The ophthalmopathy of Graves' disease improves to a greater extent after subtotal thyroidectomy than after radioiodine therapy.
Penetrating external injuries of the oesophagus and pharynx
Authors: Hatzitheofilou C , Strahlendorf C , Kakoyiannis S , Charalambides D , Demetriades D 
Published: March 2007

Abstract
Fifty-one instances of oesophageal perforation were discovered when the records of 18 588 patients with external penetrating injuries of the neck, chest and abdomen were reviewed. Of these, 33 resulted from stab wounds, 17 from bullets and one from hyperextension of the neck. There were 15 perforations of the pharynx and 36 of the oesophagus. Oesophagography in a lateral decubitus position demonstrated the perforation in all 16 patients in whom it was used. In 45 patients simple repair within 24 h of injury was performed (mortality rate 11 per cent). In six patients with a delay of more than 24 h in the repair of the thoracic oesophagus, special techniques were preferred. In two patients an oesophageal diversion-exclusion method was used; one such patient died. In four patients repair over a large-bore T tube was carried out with one death. The main cause of mortality was associated spinal injury (four deaths).
Survival following microscopically confirmed radical resection of N0 gastric cancer
Authors: Brems-Dalgaard E , Clausen H V 
Published: March 2007

Abstract
In a series of 128 patients operated on for gastric cancer, 27 satisfied microscopic criteria for radical resection. The median age of these patients was 72·3 (range 36-84) years at operation; the median hospital stay after surgery was 12·9 days. The median observation time was 3·8 years and the crude 5-year survival rate 48 per cent. Older patients did remarkably well. No significant difference was found in the number of survivors, survival-observation time or hospital stay in the age groups 55–64, 65–74 or 75–84 years. Thus, age alone should not be considered a barrier to curative surgical treatment. When the study was ended, 12 of the 27 patients who underwent microscopically confirmed radical resection were still alive; six had died from recurrent gastric cancer and nine from other causes. At 5 years after microscopically confirmed radical resection for gastric carcinoma, the gastric cancer-specific mortality rate was 23 per cent.
Factors associated with early discharge after inguinal hernia repair in 500 consecutive unselected patients
Authors: Millat B , Fingerhut A , Gignoux M , Hay J-M 
Published: March 2007

Abstract
The feasibility of discharge within 48 h of surgery was evaluated in 500 consecutive men with unilateral uncomplicated non-recurrent inguinal hernia. Fifty-nine patients were unsuitable for short-stay Surgery on medical or social grounds. Of 411 patients suitable for early discharge, 107 stayed longer than 48 h. Early discharge was declined by 84 otherwise suitable patients and contraindicated because of local or general complications in 42. A total of 304 patients were discharged within 48 h; 1-day surgery was performed in 51 patients. Employment, low physical requirements, a lower age and fewer than two medical risk factors were associated with feasible and successful short-stay surgery. These factors may not be independent variables.
Liver resection with normothermic ischaemia exceeding 1 h
Authors: Hannoun L , Borie D , Delva E , Jones D , Vaillant J-C , Nordlinger B , Parc R 
Published: March 2007

Abstract
A retrospective study was made of 34 patients who underwent major liver resection with a single period of vascular occlusion exceeding 60 min. The liver remnant was normal in all cases. Vascular occlusion was achieved by continuous portal trial clamping (15 patients), hepatic vascular exclusion (15) or a sequential combination of both procedures (four). Liver cooling was not used. The mean(s.e.m.) duration of continuous normothermic liver ischaemia was 73·6(2·5) (range 60–127) min. The mean(s.e.m.) amount of blood transfused during operation was 5·3(0·8) units packed red cells. There were no deaths after surgery and the postoperative course was uneventful, or limited to asymptomatic pleural effusion, in 18 patients. Three patients suffered postoperative bleeding necessitating further surgery and one of these required reintervention for a prolonged bile leak. Four patients had transient liver failure that resolved spontaneously within 15 days. There was a 13-fold increase in serum transaminase activities and the proaccelerin level was 45 per cent that of normal on day 1 after operation. These changes were returning to normal levels within 15 days. Continuous vascular occlusion during major liver resection is a useful manoeuvre that may be performed safely on normal hepatic parenchyma for up to 90 min.
Morphological studies of graft pancreatitis following pancreas transplantation
Authors: Büsing M , Hopt U T , Quacken M , Becker H D , Morgenroth K 
Published: March 2007

Abstract
Morphological findings in the initial stages of graft pancreatitis were studied systematically in sequential biopsies of 16 human pancreatic allografts. In 14 patients clinical and morphological signs of graft pancreatitis developed in the early postoperative period. In all cases disturbances in the integrity of structures within acinar cells occurred during ischaemia. In ten cases activation of autophagocytosis occurred following reperfusion, with acceleration of cellular metabolism. After reperfusion a marked leucocyte reaction occurred with a later single acinar cell necrosis in six cases. At the same time, high serum pancreatic enzyme concentrations were observed in all patients following transplantation. Exocrine secretion from the allografts via the pancreatic duct was reduced, correlating with the severity of graft pancreatitis. Studies in this clinical situation might complement analyses of the cascade of morphological and pathophysiological reactions during the early stages of other types of acute pancreatitis.
Percutaneously placed Wallstent endoprosthesis in patients with malignant distal biliary obstruction
Authors: Stoker J , Laméris J S , Jeekel J 
Published: March 2007

Abstract
Seventy-five patients with malignant distal biliary obstruction were treated by percutaneously placed self-expandable Wallstent endoprostheses for palliative drainage. The stent diameter was I cm and its length 3·5 – 10·5 cm. Early complications occurred in 16 patients (21 per cent); they were related to the endoprosthesis in five (7 per cent) and serious in six (8 per cent). The 30-day mortality rate was 15 per cent, with a 1 per cent procedure-related mortality rate. Sixty-five patients died 6–365 (median 87) days after stent insertion and four had recurrence of obstruction after 21–341 (median 152) days. Reobstruction was the result of tumour ingrowth in one patient, angling of the stent in one and an unestablished cause in two. Ten patients were alive without obstruction 31–383 (median 65) days after stent insertion. Percutaneous use of the Wallstent endoprosthesis allows easy insertion; reobstruction is rare.
Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection
Authors: Voros D , Pissiotis C , Georgantas D , Katsaragakis S , Antoniou S , Papadimitriou J 
Published: March 2007

Abstract
Forty-two patients with necrotizing soft tissue infection are reviewed. Bacterial culture revealed between two and seven types of micro-organism in each patient. All patients were treated with radical surgical debridement and a combination of antibiotics. In 30 patients, early diagnosis and treatment resulted in only two deaths. Delayed surgical intervention in 12 patients transferred from outside hospitals was followed by nine deaths. Predisposing factors and site of infection did not affect outcome. Of 26 patients with systemic manifestations of sepsis, 16 survivors responded well to initial surgical debridement.
Synchronous abdominoperineal resection without transfusion
Authors: De Cannière L , Rosiére A , Michel L A 
Published: March 2007

Abstract
Blood loss and hypovolaemic shock affect the immune system significantly, and perioperative blood transfusion has been shown to be associated with a higher rate of tumour recurrence in patients with cancer and increased susceptibility to infectious complications. Data obtained from patients undergoing synchronous abdominoperineal excision of the rectum were analysed to assess whether such surgery is feasible without transfusion. Twenty-two consecutive unselected patients were studied. There were 16 men and six women of median age 66 (range 48–80) years. The tumour stage was Dukes' B in 11 patients and Dukes' C in 11. Six patients were severely obese according to body mass index. Four patients required blood transfusion (1, 1, 2 and 2 units). There was no hospital mortality and all perineal wounds healed primarily with no wound infection. Fifteen patients received radiation therapy 6 weeks after surgery. Abdominoperineal resection with minimal blood transfusion is feasible in unselected patients.
Imipenem prophylaxis in elective colorectal surgery
Authors: Karran S J , Sutton G , Gartell P , Karran S E , Finnis D , Blenkinsop J 
Published: March 2007

Abstract
In a randomized controlled study of 411 patients undergoing elective colorectal surgery, the efficacy and safety of two different regimens of imipenem were compared with those of a control regimen of cefuroxime plus metronidazole. Surgical infections occurred in 92 (26·4 per cent) of 349 evaluable patients. There were no major differences between the three treatment groups. It is concluded that imipenem is as effective as cefuroxime plus metronidazole in the prevention of sepsis after elective colorectal procedures.
Infrainguinal revascularization in the diabetic patient
Authors: Stonebridge P A , Murie J A 
Published: March 2007

Abstract
This article reviews the epidemiological, anatomical and physiological background to infrainguinal arterial reconstruction in the diabetic patient. There is no firm evidence in the literature for the existence of a surgically significant occlusive ‘small-vessel’ disease in diabetic patients, either as an aetiological component in the pathogenesis of diabetic foot lesions or as a factor limiting the success of infrainguinal bypass grafting. Recent published results of infrainguinal vascular reconstruction in patients with diabetes are reviewed. These are encouraging; early aggressive treatment of lower-limb occlusive disease may be warranted in the diabetic patient.
Concurrent hyperthyroidism and thyroid carcinoma
Authors: Terzioǧlu T , Tezelman S , Onaran Y , Tanakol R 
Published: March 2007

Abstract
Between 1986 and 1991, thyroidectomy was performed on 138 patients with hyperthyroidism. Thyroid carcinoma was found in eight patients (5.8 per cent). Eighty (58.0 per cent) of the 138 patients had toxic nodular goitre, 33 (23.9 per cent) toxic diffuse goitre and 25 (18.1 per cent) toxic adenoma. Concurrent carcinoma was more frequent in patients with toxic adenoma (8 per cent) than in those with Graves' disease (6 per cent) and toxic nodular goitre (5 per cent). Papillary carcinoma was found in seven patients and follicular carcinoma in one. Three papillary carcinomas were occult with a diameter less than 1.5 cm. Five patients received 100 mCi 131I after operation. There was no morbidity. During follow-up of 10–45 months, there was neither death nor recurrence.
Thyroid neoplasia coexistent with chronic lymphocytic thyroiditis
Authors: McKee R F , Krukowski Z H , Matheson N A 
Published: March 2007

Abstract
During a 6-year period 115 patients presenting with thyroid enlargement had evidence of chronic lymphocytic thyroiditis on fine-needle aspiration cytology. Of 27 patients in whom histological analysis was carried out, 16 had neoplasms (follicular adenoma, four; follicular carcinoma, one; papillary carcinoma, four; lymphoma, seven). Assuming that neoplasia was not overlooked in the absence of histological examination, the overall incidence was 14 per cent and that of malignant disease 10 per cent. All patients with carcinoma had cytological features suspicious of neoplasia on the first or subsequent aspirates in addition to those of thyroiditis. Cytology was suspicious of lymphoma in only two of seven patients but increasing size of the thyroid swelling was a consistent feature. Evidence of chronic lymphocytic thyroiditis may lead to neoplasia being overlooked. Repeated cytological analysis is helpful in identifying coexistent carcinoma but unreliable in excluding lymphoma.
Oesophagogastrectomy for carcinoma of the oesophagus and cardia
Authors: Rahamim J , Cham C W 
Published: March 2007

Abstract
A retrospective review was undertaken of all oesophagectomies performed within a single unit over a 12-year period. In all, 298 patients with primary oesophageal cancer underwent resection between March 1979 and December 1991. Four patients had a three-stage oesophagogastrectomy, 27 a thoracoabdominal oesophagogastrectomy and 267 a Lewis procedure. Dysphagia was the predominant presenting symptom. The duration of symptoms was not related to the stage of disease. Before diagnosis, 52 per cent of patients tolerated symptoms for 2–4 months. Adenocarcinoma was found in 180 tumours and squamous cell carcinoma in 103. Half the patients had evidence of metastatic spread at the time of laparotomy or thoracotomy. The 30-day mortality rate was 10 per cent and the overall actuarial 5-year survival rate of all patients 23 per cent. The actuarial 5-year survival rate of patients without lymph node involvement was 39 per cent compared with 17 per cent for those with positive nodes (P &lt; 0·05). Five of eight patients who had anastomotic leakage died. The almost unselected nature of this series, coupled with the favourable results of oesophagectomy, support the contention that resection remains the preferred mode of treatment for carcinoma of the oesophagus of all histological types.
Reduction in circulating levels of CD4-positive lymphocytes in acute pancreatitis: Relationship to endotoxin, interleukin 6 and disease severity
Authors: Curley P J , McMahon M J , Lancaster F , Banks R E , Barclay G R , Shefta J , Boylston A W , Whicher J T 
Published: March 2007

Abstract
The proportion of peripheral blood mononuclear cells expressing the T helper cell phenotype and levels of antiendotoxin core antibody, interleukin (IL) 6 and C-reactive protein (CRP) were determined within 48 h of admission in a group of 29 patients with acute pancreatitis (16 mild, 13 severe attacks). There was a significant decrease in the proportion of T helper cells (12·2 versus 34·9 per cent, P &lt; 0·01) and significant increases in levels of IL-6 (69·5 versus &lt; 10 pg/ml, P &lt; 0·01) and CRP (119 versus 30·5 mg/l, P &lt; 0·01) in severe compared with mild attacks. During the convalescent stage at 3 months after admission, severe attacks were characterized by a significant increase in the proportion of T helper cells compared with the acute period (22·4 versus 10·6 per cent, P &lt; 0·01). A persistently low proportion of T helper cells was associated with residual pancreatic necrosis. The presence of circulating endotoxin was demonstrated in two mild and two severe attacks using the Limulus amoebocyte lysate assay, and abnormal levels of antiendotoxin core antibodies were found in 70 and 92 per cent of mild and severe attacks respectively. There was a strong inverse correlation between levels of CRP and the proportion of T helper cells in severe disease (r = −0·76, P = 0·004). Translocation of endotoxin from the gastrointestinal tract may partly explain the abnormal levels of T helper cells, IL-6 and CRP.
Effect of nifedipine on renal transplant rejection
Authors: Nicholson M L , Dennis M J S , Beckingham I J , Smith S J 
Published: March 2007

Abstract
The effect of early nifedipine therapy on acute renal allograft rejection was studied in 170 adult cadaveric transplant recipients. Acute rejection occurring in the first 3 months after transplantation was diagnosed by Tru-cut biopsy and the severity of each rejection episode assessed histologically. The incidence of acute rejection was significantly lower in patients treated with nifedipine (29 of 80; 36 per cent) than in controls (52 of 90; 58 per cent) (P &lt; 0·01) and there was a higher proportion of histologically mild rejection episodes in the former group (P &lt; 0·01). Multivariate analysis confirmed that nifedipine exerted a significant independent effect on the incidence of early acute rejection. Other factors identified in the multivariate model as influencing rejection were human leucocyte antigen (HLA) matching at the DR locus, blood level of cyclosporin during the first week, HLA matching at the B locus, donor age and donor sex. The 1-year graft survival rate was 88.6 per cent in patients given nifedipine and 63·8 per cent in controls (P &lt; 0·02). These data suggest that nifedipine therapy has a useful role in human renal transplantation.
Cytokine gene transcription in renal cell carcinoma
Authors: Filgueira L , Zuber M , Merlo A , Caetano V , Schultz E , Harder F , Spagnoli G C , Heberer M 
Published: March 2007

Abstract
Cytokines are powerful modulators of immune responses, the local production of which could be relevant to the interaction between tumour and immune system. This study investigated the transcription of genes encoding interleukin (IL) 2, IL-4, IL-10 and interferon (IFN) γ in lymphocyte-infiltrated renal cell carcinoma biopsies from ten patients using the reverse polymerase chain reaction technique. Autologous peripheral blood mononuclear cells and healthy renal parenchyma tissue were tested in parallel. The β-actin gene, used as a positive control, was transcribed in all samples. In contrast, transcription of cytokine genes was confined to tumour biopsies: IL-2 gene transcripts were detectable in five biopsies and IL-10 transcripts in seven. IL-4 and IFN-γ gene transcripts were detectable in one biopsy each. In two patients no cytokine gene transcription could be identified. These data underline that heterogeneous patterns of cytokine gene transcription can be observed in renal cell carcinoma biopsies. Although transcription of an immunostimulatory lymphokine such as IL-2 was observed in 50 per cent of biopsies, the most frequently transcribed cytokine gene coded for an inhibitory factor, IL-10.
Delay in the diagnosis and prognosis of carcinoma of the right colon
Authors: Goodman D , Irvin T T 
Published: March 2007

Abstract
Of 152 consecutive patients with carcinoma of the right colon, 61 (40 per cent) suffered delays in treatment of more than 12 weeks from the onset of symptoms, with a mean delay of 48 weeks. The most common error was failure to initiate or complete the investigation of iron-deficiency anaemia (33 patients). False-negative barium enema investigations occurred in 16 cases. Patients with delays in diagnosis had survival rates not significantly different from those who presented early. Thirty-one patients with anaemia and no abdominal symptoms had a significantly higher survival rate than 30 presenting with abdominal symptoms, despite delays in treatment (P &lt;0·02). Greater vigilance is required in the investigation of patients presenting with iron-deficiency anaemia.
‘Bile’ in the oesophagus
Authors: Bremner C G , Mason R J 
Published: March 2007

Abstract
Acid gastro-oesophageal reflux occurs when the lower oesophageal sphincter is incompetent, but oesophagitis caused by reflux of duodenal content implies incompetence of both the pyloric and gastro-oesophageal sphincters. The term ‘alkaline’ reflux oesophagitis was coined long before objective analysis was made-of bile in the stomach and oesophagus, and well before pH monitoring was introduced. Surgical procedures to divert bile from the stomach and oesophagus were developed on a clinical basis and gave encouraging results in the management of peptic oesophageal stricture. Alkaline oesophagitis is well recognized after gastric surgery and the entity ‘primary pathological duodenogastric reflux’, although contested by some, attracts growing support. Recent evidence suggests that the complications of Barrett's oesophagus may be related to duodenogastro-oesophageal reflux. Probes designed to measure gastric and oesophageal bile salts have recently been developed and may give more information in the future.
Long-term survival after endoscopic transanal resection of rectal tumours
Authors: Dickinson A J , Savage A P , McC. Mortensen N J , Kettlewell M G W 
Published: March 2007

Abstract
The outcome and survival of 120 consecutive patients of median age 78 years with rectal tumours who underwent endoscopic transanal resection were assessed. Thirty-eight patients (32 per cent) were treated for large villous adenoma. These patients underwent a median of 2 (range 1–5) resections and the overall 5-year survival rate was 78.2 per cent. Of 82 patients with rectal cancer, 33 (28 per cent of the 120) had tumours amenable to conventional surgery but for the patient's age or infirmity. The 5-year survival rate of these patients was 29.7 per cent. Endoscopic transanal resection was used to palliate the symptoms of 49 patients (41 per cent) with rectal cancer; the 5-year survival rate was 13.7 per cent. Excellent long-term outcome may be achieved with endoscopic transanal resection for patients with benign rectal tumours. This approach also gives acceptable results for selected patients with rectal cancer in whom age, extent of disease or concurrent. illness preclude conventional surgical resection.