bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of surgical local excision in the treatment of rectal cancer
Authors: Whiteway Janet , Nicholls R J , Morson B C 
Published: March 2007

Abstract
Selection of patients with ulcerating rectal cancer for treatment by local excision has been governed by a policy based on clinical and histological criteria; if these criteria are not fulfilled, major resection is recommended. This policy was re-examined in three groups of patients treated by local excision: Group 1 for cure (27 patients), Group 2 due to unfitness for major surgery (13 patients), Group 3 for local tumour control in the presence of metastatic disease (6 patients). When the policy was fulfilled, there was a cancer-specific death rate of 8.3 per cent in Group 1 (two patients with poorly differentiated tumours) and 0 per cent in Group 2. Unavoidable policy breaches occurred when patients refused major surgery or were too unfit: in the latter elderly group, this did not have the adverse effect expected. It is concluded that pre-operative clinical digital assessment and histological grading are a satisfactory means of identifying a small group of tumours appropriate for local treatment and that the results justify local excision where the policy is observed.
A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer
Authors: Chapuis P H , Dent O F , Fisher R , Newland R C , Pheils M T , Smyth E , Colquhoun Kim 
Published: March 2007

Abstract
Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.
Ultrasonographic detection of early and curable carcinoma of the gallbladder
Authors: Koga A , Yamauchi S , Izumi Y , Hamanaka N 
Published: March 2007

Abstract
Five patients with early carcinoma of the gallbladder detected by ultrasonography were studied. Three complained of non-specific upper abdominal symptoms or were asymptomatic and two had severe biliary colic. Gallstones were present in the two-patients without biliary symptoms. Early carcinoma of the gallbladder was demonstrated as a polypoid tumour by ultrasound in four patients and as thickening of the gallbladder wall in one. The tumour was over 2 cm in diameter in all but one patient in whom the tumour enlarged rapidly from 5 to 10 mm. Size of the tumour and extent of spread were closely related. All but one patient underwent curative resection. Ultrasonography enhances the detection of early carcinoma of the gallbladder especially in old patients with nonspecific abdominal symptoms and the operative cure rate is thereby improved.
Layered versus mass closure of abdominal wounds in infants and children
Authors: Kiely E M , Spitz L 
Published: March 2007

Abstract
A prospective trial of layered versus mass closure of laparotomy wounds was performed on 507 infants and children over a 33 month period. All wounds were sutured using polyglycolic acid sutures. There were four wound failures including one disruption in the layered closure group and one wound failure in the mass closure group. The incisional hernias healed spontaneously. Either method of closure yields good results and non-absorbable sutures are unnecessary.
Experimental wound healing: Increased breaking strength and collagen synthetic activity in abdominal fascial wounds healing with secondary closure of the skin
Authors: Scott P G , Chambers Margaret , Johnson B W , Williams H T 
Published: March 2007

Abstract
Delayed primary closure or secondary closure of skin and subcutaneous fat in contaminated laparotomy incisions virtually eliminates the risk of wound abscess in clinical practice. Incisional hernias rarely develop in these wounds. This experimental study offers a possible explanation. Longitudinal incisions in the linea alba of female Wistar rats healed under skin incisions which were either sutured (‘closed’ subgroup) or left to close by secondary intention (‘open’ subgroup). Postoperative breaking strengths and collagen contents (measured as hydroxyproline) were studied at intervals of 3-120 days. Measurable strength developed by 5 days, at which time ‘open’ subgroup wounds were found to be weaker and to have less collagen. At all other times, however, ‘open’ subgroup wounds were stronger, a property which could be ascribed at earlier, but not at later, periods (42 or 120 days), to a higher content and concentration of collagen. At 3 days the rate of collagen production was significantly (P&lt;0·025) lower in ‘open’ than in ‘closed’ subgroup wounds but the converse was true at 6 and 9 days (P&lt;0·025), thus accounting for the changes in biomechanical properties. It is suggested that initially the stimulus for collagen synthesis is greater in the ‘open’ wounds and this leads to the development of a collagenous structure which is better adapted to resist tensile forces.
The effect of antiseptics on the healing wound: A study using the rabbit ear chamber
Authors: Brennan S S , Leaper D J 
Published: March 2007

Abstract
The effects of several antiseptic agents on granulation tissue were studied using rabbit ear chambers as models of the healing wound. This enabled us to study dynamically the action of these agents on the microcirculation of the wound. All the agents tested caused some adverse effect, but in the cases of hypochlorite antiseptics Eusol and Chloramine T, blood flow in the capillary circulation of the granulation tissue ceased and the process of repair was subsequently delayed. A laser Doppler flowmeter was used to measure these changes in local perfusion which reflected the toxic effects seen on microscopy of the ear chamber.
Effects of bile, infection and pressure on pancreatic duct integrity
Authors: Armstrong C P , Taylor T V , Torrance H B 
Published: March 2007

Abstract
Ionic flux, potential difference and mucosal ultrastructure have been studied in the rat bile—pancreatic duct and the effects of pressure, bile and infection on the duct evaluated. The duct remained stable after perfusion with control solution under low pressure and high pressure produced widening of intercellular spaces only. Perfusion with a bacterial solution of Escherichia coli did not effect significant changes. Sterile human bile disturbed the integrity of the duct by increasing ionic flux, altering potential difference and producing reversible ultrastructural changes of cell oedema. High pressure increased these changes. Infected human bile under high or low pressure was by far the most toxic substance tested. Perfusion with infected bile led to irreversible duct damage and complete loss of duct integrity. Pressure and infected bile may have a role in damaging duct integrity and could thus play an integral part in the genesis of acute gallstone pancreatitis.
Malignant melanoma of the hand and foot: Diagnosis and management
Authors: Hughes L E , Horgan K , Taylor B A , Laidler P 
Published: March 2007

Abstract
Forty-six patients with melanoma of the hand (5) and foot (41) studied prospectively between 1972-84 have been reviewed to determine guidelines for diagnosis and management. The clinical appearance is varied and the lesions are often misdiagnosed as warts or fungal infections. Clinical assessment of tumour thickness on the sole is difficult because of the nature of the plantar skin. Incision rather than excision biopsy is indicated because of the functional consequences of large excisions on the hand and foot. Melanoma of the toe was treated by local metatarsophalangeal amputation. Plantar melanomas were excised with a 3 cm margin. Dorsum melanomas were treated by a selective policy of 1, 2 or 3 cm margins according to clinical assessment of tumour thickness. These policies have resulted in only one case of local recurrence. An in situ Silastic foam mould facilitates immediate application of split skin grafts to irregular areas. The functional results of split skin grafts on sole and heel have been satisfactory. Toe lesions were thickest, dorsum thinnest, sole and heel intermediate. The prognosis related to these groupings of tumour thickness. Simultaneous clinical nodal involvement carried a hopeless prognosis, and most patients developing nodes within 2 years die—unless treated by prophylactic dissection. The role of prophylactic dissection is still not defined, but it is likely that it will be used more frequently in the future. Early diagnosis offers most hope of improving the outlook. Many elderly patients with nodular lesions have had moles for many years. Younger patients are now being seen with thin lesions, even on the toe.
CAPD and renal transplantation
Authors: Donnelly P K , Shenton B K , Lennard T W J , Proud G , Taylor R M R 
Published: March 2007

Abstract
Continuous ambulatory peritoneal dialysis (CAPD) is believed to improve the immune competence of end-stage renal failure patients and to increase the risk of graft rejection following subsequent renal transplantation. At this centre, 220 consecutive renal transplants have been studied in patients treated by either CAPD or haemodialysis (HD). Patient and graft survival was not significantly different for the two treatment groups over a five year follow-up. When only first cadaver recipients were considered (152 grafts) one-year graft survival (non-immunological failures excluded) was 77 per cent for CAPD and 79 per cent for HD patients (P&gt;0·05). Time on dialysis and number of pre-operative transfusions were significantly greater for the HD patients (P&lt;0·05). A group of HD and CAPD patients were identified as being matched for age, sex, HLA, A, B, DR antigen matches, pre-operative transfusions and time-on dialysis. One-year graft survival of the CAPD patients was 82 per cent and for the HD patients 61 per cent. Studies of patient lymphocyte function and plasma suppressive activity in vitro revealed no differences between CAPD and HD treated patients. CAPD is not an immunological risk factor in renal transplantation and its continued use in the preparation of patients for transplantation is recommended.
The influence of tumour cell DNA abnormalities on survival in colorectal cancer
Authors: Armitage N C , Robins R A , Evans D F , Turner D R , Baldwin R W , Hardcastle J D 
Published: March 2007

Abstract
The cellular DNA content was measured from paraffin-embedded material in 134 colorectal cancers from patients in whom the outcome was known. Seventy-two (55 per cent) were found to contain cells with abnormal DNA (DNA aneuploid). The presence of such a population of cells was not related to pathological stage or histological grade. However, only 14 (19 per cent) patients with DNA aneuploid tumours survived 5 years compared with 27 (43 per cent) of patients with diploid tumours (χ2 = 8·0, P = 0·005). Stepwise logistic analysis showed cellular DNA content to be an important prognostic factor in colorectal cancer, independent of pathological stage and histological grade.
An assessment of occult blood testing to determine which patients with large bowel symptoms require urgent investigation
Authors: Farrands P A , O'Regan D , Taylor I 
Published: March 2007

Abstract
One hundred and fifty-two consecutive patients with symptoms suggestive of colorectal disease were offered occult blood testing before undergoing barium enema examination or colonoscopy; one hundred and thirty-nine successfully completed the test. Thirty-four had positive results of whom thirteen had a cancer and eight an adenomatous polyp (diagnostic yield for neoplasia of 59 per cent). No false negative results occurred, a sensitivity of 100 per cent, and only 21 false positives occurred, a specificity for malignancy of 84 per cent. Subjects attending outpatients should be offered occult blood testing; those with a positive test should undergo colonoscopy. The cost-benefit of such a scheme is emphasized.
Fibro-adenoma of the breast
Authors: Wilkinson S , Forrest A P M 
Published: March 2007

Abstract
A retrospective study of 134 patients with a clinical diagnosis of fibro-adenoma of the breast indicated that histological confirmation of this diagnosis is made in only 50 per cent. The majority of the others have a diagnosis of benign mammary dysplasia. Eight patients had an unsuspected carcinoma, all but one being above the mean age for the fibro-adenoma group. The natural history of fibro-adenoma is not known precisely. In view of the high sensitivity of fine needle aspiration cytology in the diagnosis of malignant disease, we believe that there is justification to carry out a prospective study to determine this. In this study women with a clinical diagnosis of fibro-adenoma will be carefully observed provided they are less than 35 years of age and fine-needle aspiration cytology reveals no malignant cells.
The role of greater omentum in reconstructing skin and soft tissue defects of the groin and axilla
Authors: Watkins R M , Meirion Thomas J 
Published: March 2007

Abstract
In three patients undergoing extended inguinal (2) or axillary (1) block dissection for recurrent malignant disease use of conventional reconstructive methods was not possible. Transposed greater omentum was used to provide a vascularized base for split-thickness skin grafts in two patients and to protect a vascular prosthesis placed in heavily irradiated tissues in the third. In each case whole limb ablation was avoided and the salvaged limb showed good function. No local recurrence of malignant disease was seen.
Reticulo-endothelial function in rats with obstructive jaundice
Authors: Tanaka N , Ryden S , Bergqvist L , Christensen P , Bengmark S 
Published: March 2007

Abstract
Reticulo-endothelial function was evaluated by measuring the biokinetics of a standardized 99mTc-sulphur colloid using scintillation camera technique in rats with biliary obstruction. There was no difference in the uptake of the colloid in the liver (K1) between sham operation and biliary obstruction at 1 week and 3 weeks. However, when corrected for changes in liver volume, the corrected colloidal uptake rate (cK1) of the liver was significantly decreased in 1 week's biliary obstruction (P&lt;0.005 compared with sham operation) and 3 weeks' biliary obstruction (P&lt;0.025 compared with 1 week obstruction). Colloidal uptake rate of the extrahepatic reticulo-endothelial system (K2) was significantly increased (P&lt;0.005) in rats with 3 weeks' biliary obstruction. Activity distribution of 99mTc-sulphur colloid in 3 weeks' biliary obstruction was significantly decreased in both total organ basis and per gram basis (P&lt;0.005). The results demonstrated a depression of RE activity of the liver in biliary obstruction.
The effect of gastric partitioning on gastric emptying in morbidly obese patients
Authors: Gannon M X , Pears D J , Chandler S T , Fielding J W L , Baddeley R M 
Published: March 2007

Abstract
Gastric partitioning is undertaken for morbid obesity but the mechanism by which weight loss is achieved is unclear. The effect of partitioning on gastric emptying has therefore been studied. In thirty patients with a mean weight of 124.6 ± 7.3 kg (± s.e.m.), a stapling technique was used to create a 50 cm3 upper gastric reservoir which communicated via a 10 mm stoma with the distal stomach. Twenty-four pre-operative and nineteen postoperative gastric emptying studies were performed using separate 50cm3 solid and liquid 113mIn-labelled meals. The time taken to achieve 50 per cent gastric emptying and the delay in isotope reaching the duodenum were measured from gamma camera images. There was no correlation between the pre-operative weight of the patients and their gastric emptying rates. The median 50 per cent gastric emptying time for solids was increased from 21 min (range 8–34) to 37.5 min (range 8–60) (P&lt;0.001), unpaired Wilcoxon), but was little changed from 17 min (1.5–30) to 16 (1.5–30) min using liquids. Delay in arrival at the duodenum was increased for solids from 0.5 min (.5–13) to 2.5 min (0.5–42.5) (P&lt;0.05) but again there was no significant effect on liquid emptying. Postoperative 50 per cent emptying time for solids correlated with mean weight loss at 3, 6, 9 and 12 months (P&lt;0.05). Following gastric partitioning there is delayed emptying of solids with related weight loss but liquid emptying is unaffected.
Pre- versus postoperative radiotherapy in rectal carcinoma: an interim report from a randomized multicentre trial
Authors: Påhlman L , Glimelius B , Graffman S 
Published: March 2007

Abstract
Since October 1980 a randomized multicentre trial has been in progress among patients with rectal carcinoma, in whom high-dose fractionated pre-operative irradiation (total dose 25.5 Gy in 5–7 days) is being tested against postoperative irradiation to a high dose level using a conventional fractionation scheme (totally 60 Gy in 8 weeks) delivered only to a high-risk group of patients (Dukes' stages B and C). The primary aim of the trial is to investigate whether local recurrence rate differs between the two groups, and a secondary aim is to see whether 5-year survival will differ between the two groups of patients. Up to October 1984, 360 patients have been randomly allocated to these two groups. Locally curative surgery has been performed in 161 patients in the pre-operative irradiation group and in 152 patients in the postoperative irradiation group. Pre-operative irradiation was extremely well tolerated and there were no irradiation-related complications; 95 per cent of these patients received their treatment according to the intended schedule. However, 48 of the 161 patients had a tumour in Dukes' stage A. Pre-operative radiotherapy had no impact on postoperative mortality or the occurrence of anastomosis dehiscence, but significantly more patients with perineal wound sepsis after an abdominoperineal resection were found in the group of patients receiving pre-operative radiotherapy. This prolonged the stay in hospital after surgery. Postoperative radiotherapy was not so well tolerated as pre-operative treatment, and in a substantial number of patients the treatment could not be commenced until a relatively long time after surgery. To date, the local recurrence rate is acceptably low (≈ 10 per cent) in both treatment groups.
The effects of different suture techniques on collagen metabolism in experimental distal colonic anastomoses
Authors: Yesilkaya Y , Soyhan N , Bengisu N , Sen M , Aritas Y 
Published: March 2007

Abstract
Two types of suture techniques have been compared in anastomoses of the distal colon in 20 mongrel dogs. They were divided into four groups, each consisting of five dogs. In A and C groups a single layer suture technique, and in B and D groups a two layer suture technique was used. In order to determine tissue hydroxyproline activities at the suture lines, the anastomosed segments were resected on the fifth day in A and B, and on the tenth day in C and D groups. It was observed that the hydroxyproline activities in single layer anastomoses were higher than those of two layer anastomoses with the implication that there was more rapid wound healing.
New method for the dynamic assessment of anorectal function in constipation
Authors: Womack N R , Williams N S , Holmfield J H M , Morrison J F B , Simpkins K C 
Published: March 2007

Abstract
A new dynamic technique for the investigation of anorectal function has been developed. This involves radiological visualization of the rectum during voiding of a semisolid radio-opaque contrast medium, and simultaneous measurement of the intrarectal pressure and electrical activity of the external anal sphincter. The method has been used to study patients (n = 16) with profound difficulty passing formed stool. It has demonstrated an abnormal increase in the activity of the puborectalis and superficial anal sphincter muscles during voiding in these patients, compared with normal subjects (n = 6). The inability to void was associated with failure to widen the anorectal angle on straining.
What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods
Authors: Oettle G J , Roe A M , Bartolo D C C , McC. Mortensen N J 
Published: March 2007

Abstract
The ‘perineometer’ underestimated movement of the pelvic floor by nearly 60 per cent in 21 patients tested; mean descent was 1.2 cm, compared with a radiographic mean descent of 2.9 cm (P &lt; 0.001). Since the instrument measures movement of the anal verge, not the pelvic floor, no account is taken of anal canal shortening. Radiographic methods are still necessary for the reliable identification of abnormal descent.
Effect of adjuvant chemo- or immunotherapy on the prognosis of colorectal cancer operated for cure
Authors: Wunderlich M , Schiessel R , Rainer H , Rauhs R , Kovats E , Schemper M , Dittrich Ch , Micksche M , Sedlacek H H 
Published: March 2007

Abstract
After radical surgery for colorectal cancer, 178 patients with a Dukes' B or C tumour were randomly assigned to one of three groups: A, controls (n=62); B, chemotherapy (n=59); C, immunotherapy (n=57). Randomization criteria (age, sex, Dukes' stage, localization of tumour, operative procedure) were evenly distributed throughout the groups. After a median observation time of 30 months, statistical analyses were performed: survival and probability to be free of recurrence was described by Kaplan—Meier estimates of the survival function; for comparison of these survival functions, Breslow's test was used. Overall analyses show no benefit in the treatment group compared to controls. Separate analyses by Dukes' stages showed that in patients with Dukes' C tumours the probability of survival 40 months after surgery was 72 per cent in group C, 51 per cent in group B, and 33 per cent in group A. The differences between groups C and A, and B and A were statistically significant (P&lt;0.02 and P&lt;0.03 respectively). For a Dukes' C tumour the probability to be free of distant metastases at 30 months after surgery was 80 per cent in group B, 68 per cent in group C and 52 per cent in group A. Also for a Dukes' C tumour the probability to be free of liver metastases at 21 months after surgery was 83 per cent in group B, 81 per cent in group C, and 54 per cent in group A (significant differences: B—A and C—A P&lt;0.04 for both). There was no influence on the estimated incidence of local recurrences for stage Dukes' C. Patients with a Dukes' B tumour did not benefit from either of the adjuvant therapy schemes.
Extended indications for polypropylene mesh closure of the abdominal wall
Authors: Chan S T F , Esufali S T 
Published: March 2007

Abstract
Over a two-year period (1982–1984) polypropylene (Marlex) mesh was used without closing the abdominal wound in 21 patients judged clinically likely to require further abdominal exploration. A total of 43 meshes were implanted. All 21 patients had more than one major laparotomy, median 3 laparotomies (range 2–7) for drainage of pus (76 per cent) and/or intestinal leakage (67 per cent). Definitive abdominal wound closure after removal of polypropylene mesh was either by delayed primary suturing (33 per cent) or consisted of split skin grafting on the granulating wound (24 per cent). Three wounds were left to granulate without skin grafting (14 per cent). Mortality in this group of patients was 29 per cent and no complications resulted directly from implantation of polypropylene mesh. Polypropylene mesh closure of the abdominal wall not only provides simple and rapid access to the abdomen but also allows free drainage and daily inspection for the development of fistulae or the seepage of pus which are indications for further exploration. In that the clinical outcome is relatively favourable in this group of critically ill surgical patients who required multiple laparotomies within a short interval, it is suggested that mesh closure of the abdominal wound is indicated whenever abdominal reentry is judged probable or rational.