bluuebunny/crossref_metadata_2025_split huggingface dataset:
Collagen changes around intestinal anastomoses in germ-free rats
Authors: Mastboom W J B , Hendriks T , de Boer H H M 
Published: March 2007

Abstract
The changes in collagen, measured as hydroxyproline, concentration around both ileal and colonic anastomoses in germ-free and control rats have been investigated and compared with each other. The germ-free rats were raised, operated on and maintained under completely pyrogen-free conditions. Animals were killed 2, 3 or 7 days after operation. There was a significant reduction in the lowering of hydroxyproline concentrations around the colonic anastomosis of germ-free rats compared with control rats both in the anastomosis at days 2 and 3 (P = 0.04 and P = 0.006 respectively) and in the proximal segment at day 3 (P = 0.03). In ileal anastomoses, significant differences between control and germ-free rats were only found at 7 days. Here the increase in hydroxyproline concentration observed in control rats was significantly reduced in germ-free rats. These data are taken to support the hypothesis that bacteria affect colonic anastomotic healing by contributing to postoperative collagen degradation.
Abdominal aortic aneurysms: A review of current problems
Authors: Cheatle T R , Scurr J H 
Published: March 2007

Abstract
This review examines the aetiology and possible methods of prevention of abdominal aortic aneurysm. The natural history of the lesion is discussed. Given its poor prognosis, surgery should be considered even when the patient is over 80 years of age, has stable cardiovascular disease and has a small aneurysm. The case for population screening is reviewed and potential areas of advance in management are outlined.
Clinical, radiological and cytological diagnosis of breast cancer in young women
Authors: Ashley S , Royle G T , Corder A , Herbert A , Guyer P B , Rubin C M , Taylor I 
Published: March 2007

Abstract
In women over the age of 35 years, an accurate diagnosis of breast cancer can be made in over 95 per cent of patients using a ‘triple assessment’ system collating information from clinical examination, mammography, sonomammography, and fine-needle aspiration cytology. These methods have not been specifically evaluated in women aged 35 years or less, hence a study was undertaken on 30 such patients. Clinical examination was unreliable in predicting malignancy with a sensitivity of only 37 per cent. Thirty per cent of patients presented with a lump which had the clinical features of a fibroadenoma. Radiological methods were less sensitive in detecting malignancy in this age group than in older patients. The sensitivity of aspiration cytology was 78 per cent which was higher than that for breast cancer at all ages. Histology showed that there were fewer low grade tumours and fewer scirrhous tumours in this age group than in a control group of women aged over 35 years. This study indicates that cytological confirmation of apparently benign focal breast lesions in young women is essential, especially when these are managed conservatively.
Adverse effects of preoperative hepatic artery chemoembolization for resectable hepatocellular carcinoma: A retrospective comparison of 138 liver resections
Authors: Nagasue Naofumi , Galizia Gennaro , Kohno Hitoshi , Chang Yu-Chung , Hayashi Takafumi , Yamanoi Akira , Nakamura Teruhisa , Yukaya Hirofumi 
Published: March 2007

Abstract
During the past 8 years we have treated 268 patients with primary hepatocellular carcinoma (HCC); total extirpation of the tumor was carried out in 138. Thirty-one of the patients with resectable HCCs had already been treated with transcatheter arterial embolization (TAE) of the liver before they were referred to us. The clinical values of preoperative TAE were retrospectively evaluated for those 31 patients and for the remaining 107 patients without TAE. There were no substantial differences between the two study groups in the clinical and histopathologic backgrounds. No differences were observed in the extent of liver resection, estimated blood loss during surgery, and operation time. During surgery, however, troublesome intra-abdominal complications relevant to TAE were encountered in 15 patients, and detection of tumors was impossible, even with intraoperative ultrasonography, in five patients in the group with TAE. Such findings were not present in any of the patients without TAE. Postoperative morbidity and mortality rates were similar in the two groups. There was no significant difference in the rate of recurrence of tumor in the liver, but the recurrence time was significantly shorter in the group with TAE. TAE did not improve the long-term survival rates in patients either with or without cirrhosis. Results of our study seem to indicate that preoperative TAE is meaningless in the treatment of resectable HCCs and therefore should be avoided, particularly in patients with advanced cirrhosis of the liver.
Wide local excision as the sole primary treatment in elderly patients with carcinoma of the breast
Authors: Reed M W R , Morrison J M 
Published: March 2007

Abstract
Clinically localized carcinoma of the breast in 96 women was treated by wide local excision alone. The locoregional recurrence rate was 35 per cent at a mean follow-up of 47 months. There was no significant effect of recurrence on survival because of the relatively high mortality rate from unrelated conditions in these mainly elderly patients. Recurrence was successfully managed with tamoxifen in the majority of cases, with few patients requiring radiotherapy or further surgery. Recurrence in the breast was associated with significantly less systemic disease and mortality than recurrence in the axilla.
Platelet aggregability after endoscopic intravariceal injection of 5 per cent ethanolamine oleate into oesophageal varices
Authors: Yamaga H , Hashizume M , Kitano S , Higashi H , Sugimachi K 
Published: March 2007

Abstract
Platelet aggregability and the coagulative and fibrinolytic systems were examined in 45 patients who underwent endoscopic injection sclerotherapy for oesophageal varices. Five per cent ethanolamine oleate, the sclerosant used, was injected into the oesophageal varices. There were significant increases in the concentrations of fibrinopeptide A, fibrinopeptide B-β-15–42 and fibrin degradation products-E after the sclerotherapy. At 1 h after the sclerotherapy the mean(s.e.m.) platelet aggregation was significantly suppressed to 71·9(4·2) per cent of that before the treatment (P &lt;0·01). There was a gradual recovery within 1 week to the same level seen before the sclerotherapy. Thomboxane B2 and 6-keto-prostaglandin F1α, both stable products of thromboxane A2 and prostacyclin respectively, showed significant temporary increases after the sclerotherapy (P &lt;0·01). The peak increase in the level of thromboxane B2 was noted within 1 h after the sclerotherapy and earlier than that for 6-keto-prostaglandin F1α. This increased ratio of prostacyclin and thromboxane A2 may be related to the marked limitation in platelet aggregation.
Transabdominal gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices
Authors: Al-Kraida A , Qazi S A , Shaikh M U , Asi S A , Al-Mofarreh M A , Al-Turki M 
Published: March 2007

Abstract
Fifty consecutive unselected patients presenting with acute haematemesis and melaena from endoscopically confirmed bleeding oesophageal varices were treated by one-stage transabdominal oesophageal transection with gastro-oesophageal devascularization and splenectomy. According to Child's classification, 15 were Grade A, 29 Grade B and six Grade C. The mortality rate was 10 per cent. Postoperative complications included gastric fundal leak (4 per cent), pleural effusion (4 per cent), subphrenic abscess (2 per cent), atelectasis (2 per cent) and pneumothorax (2 per cent). Although five patients (10 per cent) complained of transient dysphagia during follow-up, only one (2 per cent) presented evidence of stricture at the site of oesophageal transection. Clinical encephalopathy was not present in the surviving patients in the postoperative period. No recurrence of bleeding has been recorded in the surviving patients over a follow-up period of 2–3 years.
Sham feeding for testing gastric secretory capacities before and after parietal cell vagotomy
Authors: Gilly F , Chabal J , Boulez J , Minaire Y 
Published: March 2007

Abstract
The usefulness of acid secretory data collected during a modified shamfeeding (MSF) test was examined in 50 patients suffering from duodenal ulcer before and after parietal cell vagotomy. In these patients basal acid output pentagastrin-stimulated acid output and MSF-stimulated acid output were measured. Preoperative MSF-stimulated acid output was found to be correlated with preoperative basal acid output, and postoperative MSF-stimulated acid output was correlated with both preoperative basal acid output and postoperative basal and pentagastrin-stimulated acid outputs. The addition of preoperative MSF-stimulated acid output to preoperative pentagastrin-stimulated acid output did not noticeably increase the close relationship between the latter and postoperative pentagastrin-stimulated acid output. It is concluded that basal and MSF-stimulated secretory rates overlap. Therefore, it is suggested that in both preoperative and postoperative conditions the addition of the sham-feeding test to the more simple basal and pentagastrin-stimulated studies could be discarded.
Anterior lesser curvature laser seromyotomy with posterior truncal vagotomy: A potential treatment of peptic ulcer disease
Authors: Hunter J G , Becker J M , Lee R G , Christian P E , Dixon J A 
Published: March 2007

Abstract
Anterior lesser curvature seromyotomy combined with posterior truncal vagotomy has been suggested as an alternative to proximal gastric vagotomy in the treatment of peptic ulcer. The argon laser may be an ideal instrument for performing seromyotomy. This study compares anterior lesser curvature argon laser seromyotomy/posterior or truncal vagotomy with anterior proximal gastric vagotomy/posterior truncal vagotomy in a canine preparation. Six dogs underwent anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy and six others underwent anterior proximal gastric vagotomy/posterior truncal vagotomy. Gastric emptying and acid secretion studies were performed preoperatively and at 1 and 6 months postoperatively. Operating time and blood loss were determined. Anterior lesser curvature argon laser seromyotomy was performed with the argon laser at 10 W, continuous, delivered through a 600 μm unsheathed quartz fibre. Anterior proximal gastric vagotomy and posterior truncal vagotomy were performed in the standard fashion. Solid phase gastric emptying was slowed with both operations (P &lt;0·05) but this was not manifest clinically. Blood loss (millilitres) was less following anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy than following anterior proximal gastric vagotomy/posterior truncal vagotomy (21(6·8) versus 95(28·1), mean (s.e.m.), P &lt;0·05) but operating time was not significantly different between the groups. Mean basal acid secretion was reduced by 64 per cent 6 months after anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy (P &lt;0·05) and by 53 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). Mean stimulated acid secretion was reduced by 41 per cent 6 months after anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy (P &lt;0·05) and by 24 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). We conclude that anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy is an acceptable alternative to anterior proximal gastric vagotomy/posterior truncal vagotomy and may provide superior parietal cell denervation with less operative blood loss.
Comparison of digital and manometric assessment of anal sphincter function
Authors: Hallan R I , Marzouk D E M M , Waldron D J , Womack N R , Williams N S 
Published: March 2007

Abstract
Anal sphincter function was assessed by digital examination and anal canal manometry in 66 patients and controls. Digital scores were allotted by using visual analogue scales for basal and squeeze sphincter function and were compared with the corresponding pressures. There were good correlations between digital basal score and maximum basal pressure (Spearman rank correlation coefficient rs = 0·56, P &lt;0·001), and digital squeeze score and maximum squeeze pressure (rs = 0·72, P &lt;0·001). There were wide ranges of sphincter function on digital and manometric assessment with considerable overlap between patient groups. Digital scores detected differences in sphincter function between patient groups as accurately as manometry. The sensitivities and specificities of digital scores and anal canal manometry in segregating continent and incontinent patients were similar. It was concluded that digital estimation was equally as good an assessment of anal sphincter function as anal canal manometry.
Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–84: The hostile action casualty system
Authors: Mellor S G , Cooper G J 
Published: March 2007

Abstract
Death and injury due to terrorist bombings continue to exercise civilian and military surgeons alike. In this paper 828 servicemen killed and injured by explosions in Northern Ireland have been studied, using data stored in the Hostile Action Casualty System (HACS). Because of the nature of the conflict in Northern Ireland, the magnitude of each explosion and the distance of the victims from it are quite accurately known. The overpressure (blast loading) to which the victim was exposed can be estimated from the information on the HACS forms and standard tables, giving overpressures for a given charge at a known distance. Using the HACS data, the numbers of injuries due to overpressure (primary blast injury), missiles energized by the blast (secondary injury), displacement of the victim by the blast wind (tertiary injury) and flash burn can be determined. Of the 828 servicemen involved in explosions, 216 were killed, most of them before any treatment could be instituted. Of the servicemen in the survey, 90 per cent were wearing body armour. Although body armour affords considerable protection from secondary missiles, it is unlikely to reduce the number of deaths due to primary blast injury.
Acute lower limb arterial ischaemia: A role for continuous oxygen inhalation
Authors: Berridge D C , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Simultaneous readings of transcutaneous partial pressure of oxygen (Ptc,O2) were obtained from the left anterior chest wall, from 10 cm distal to the medial aspect of the knee joint, and from the first dorsal webspace in 16 patients with acute peripheral arterial ischaemia of the leg. Oxygen was administered at concentrations of 24, 40, 60 and 100 per cent. Mean(s.d.) initial chest Ptc, O2 (53 (17) mmHg) was significantly higher than that of the medial lower limb site (37(17) mmHg). After inhalation of 24 per cent oxygen, a statistically significant (P &lt; 0.025) increase in chest Ptc, O2 was achieved (63(20) mmHg), but the increase in Ptc, O2 (43(19) mmHg) at the medial lower limb site was not statistically significant. Inhalation of 40 per cent oxygen resulted in significant increases at both sites (chest: 83(23) mmHg, P &lt; 0.01; limb: 53(26) mmHg, P &lt; 0.05). Ptc, O2 in the limb at this concentration of inhaled oxygen was equal to the initial chest level. Increasing the oxygen concentration to 60 per cent and then to 100 per cent produced further significant (P &lt; 0.001) increases in Ptc, O2 at both sites. The use of continuous oxygen inhalation during acute ischaemia may improve tissue nutrition before, during and after definitive treatment.
Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: A prospective comparison for detecting intra-abdominal metastases
Authors: Watt I , Stewart I , Anderson D , Bell G , Anderson J R 
Published: March 2007

Abstract
We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86–100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P&lt;0.01; P&lt;0.02) and more accurate (P&lt;0.01; P&lt;0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P&lt;0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.
Resectability of large focal liver lesions
Authors: Baer H U , Gertsch Ph , Matthews J B , Schweizer W , Triller J , Zimmermann A , Blumgart L H 
Published: March 2007

Abstract
Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, ‘hanging’ tumours (n = 7) were resected in six cases, expansively growing ‘pushing’ tumours (n = 19) were resected in 18 cases, and infiltrating, ‘invasive’ tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (&lt;5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.
Bile leaks after simple cholecystectomy
Authors: Rayter Z , Tonge C , Bennett C E , Robinson P S , Thomas M H 
Published: March 2007

Abstract
Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethyl-phenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.
Critical assessment of the quality of continence after postanal repair for faecal incontinence
Authors: Yoshioka K , Keighley M R B 
Published: March 2007

Abstract
One hundred and twenty-four patients had a postanal repair for the treatment of faecal incontinence between January 1976 and July 1987. One hundred and sixteen of these patients have been followed up for more than 1 year with a median follow-up of 5 years. Incontinence was improved in 81 per cent of patients. Furthermore, bowel frequency fell: 58 per cent had more than four bowel movements before operation compared with 19 per cent after operation. However, 60 per cent of patients still claimed urgency, 76 per cent still leaked faeces and 52 per cent continued to wear pads after the operation. Maximum resting anal pressure and maximum squeeze pressure did not change significantly after operation either in patients whose bowel control was improved or in those who were not. The results indicate that the quality of continence after postanal repair is poor.
Gastrointestinal malignancy: Rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy
Authors: Cunliffe W J , Sugarbaker P H 
Published: March 2007

Abstract
The treatment of gastrointestinal cancer and the prognosis of patients with this disease have changed very little over the past several decades. No screening tools have been developed which allow this disease to be surgically treated for cure at an early stage. None of the forms of adjuvant chemotherapy instituted in the months and years after surgical resection of cancer have been successful. We show that resection site recurrence and spread of disease on the peritoneal surfaces are the most common sites for surgical treatment failure. By changing the route of administration and the timing of chemotherapy, the efficacy of drugs now routinely employed in gastrointestinal cancer can be markedly improved. Our early studies suggest that there is a definite change in the natural history of these malignancies when intraperitoneal chemotherapy is administered immediately after surgery. The pharmacology and physiology of drug delivery in the immediate postoperative period are explored. Toxicity studies have been performed in a series of treatment protocols already in use. These protocols need to be subjected to randomized controlled trials in the near future.
Abdominal pain: a surgical audit of 1190 emergency admissions
Authors: Irvin T T 
Published: March 2007

Abstract
In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17-per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10–29 years (31 per cent) and 60–79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20–29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4·4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged ≥60 years, and patients aged 80–89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.