bluuebunny/crossref_metadata_2025_split huggingface dataset:
Activities of phospholipase A2 and diacylglycerol lipase are increased in human colorectal cancer
Authors: Hendrickse C W , Radley S , Donovan I A , Keighley M R B , Neoptolemos J P 
Published: March 2007

Abstract
Experimental, clinical and epidemiological studies have implicated arachidonic acid and its metabolites as important mediators in colorectal carcinogenesis. Although arachidonic acid levels are increased in tumour membrane lipids, its availability for metabolic processes is not known. The activities of phospholipase A2 (PLA2) and diacylglycerol lipase therefore were assessed in tumour and normal mucosal specimens from 20 patients with colorectal cancer using 14C-radiolabelled substrates. The median (interquartile range) PLA2 activity was increased in tumour tissue (10.5 (6.0, 18.5) pmol arachidonic acid mg−1 h−1) compared with that in normal mucosa (5.6 (2.5, 8.5) pmol arachidonic acid mg−1 h−1) (P &lt; 0.001, Wilcoxon signed rank test). Activity of diacylglycerol lipase was also greater in tumoral tissue (47.4 (21.6, 82.1) pmol arachidonic acid mg−1 h−1) than in mucosa (19.1 (9.4, 42.9) pmol arachidonic acid mg−1 h−1) (P &lt; 0.005). There was no correlation between either PLA2 or diacylglycerol lipase activity and myeloperoxidase activity, suggesting that these increases were not directly attributable to tumour inflammatory cell infiltrate. Augmentation of arachidonic acid release in colorectal tumours may have implications for therapy.
Inadequate levels of metronidazole in subcutaneous fat after standard prophylaxis
Authors: Badia J M , de la Torre R , Farré M , Gaya R , Martínez-Ródenas F , Sancho J J , Sitges-Serra A 
Published: March 2007

Abstract
The efficacy of antibiotic prophylaxis depends on appropriate tissue levels of the drug being present at the time of potential wound contamination. Metronidazole concentrations in serum, muscle and subcutaneous fat were measured after a single intravenous dose given at two different intervals before operation. Twenty-six patients undergoing abdominal wall procedures were divided into two groups. Patients in group 1 received metronidazole 500 mg intravenously 2 h before surgery, and those in group 2 were given the drug during induction of anaesthesia. Mean plasma levels of metronidazole at the beginning of the procedure were significantly lower (P = 0.01) in group 1 (7.3 (95 per cent confidence interval 5.7–8.9)) μg/ml than in group 2 (12.3(8.9–15.7)) μg/ml although in both cases were above the minimum inhibitory concentration for 90 per cent of Bacteroides fragilis. Similar therapeutic concentrations of metronidazole were achieved in plasma and muscle in both groups at the end of the operation. However, patients in both groups had non-therapeutic concentrations of metronidazole in subcutaneous fat: group 1 0.9 (0.6–1.2)μg/mg, group 2 1.2 (0.7–1.7)μg/mg at the beginning of operation, and 1.2 (0.8–1.6) and 1.5 (0.9–2.1)μg/mg respectively at the end of the procedure. It is concluded that infusion of metronidazole 2 h before surgery or during induction of anaesthesia achieved adequate plasma and muscle levels but failed to achieve therapeutic levels in subcutaneous fat.
Acute thrombotic occlusion of the suprarenal aorta: Importance of early diagnosis and treatment
Authors: Mestres C A , Castella M , Barriuso C , Mulet J 
Published: March 2007

Abstract
Five patients with suprarenal aortic thrombosis were diagnosed and treated over the past 6 years. Attempts were made to establish aggressive medical and surgical treatment promptly. Three patients died in spite of immediate therapeutic measures. Two patients survived operation but one died 9 months later from myocardial infarction. The syndrome of high acute aortic occlusion is considered; attention is focused towards immediate diagnosis and treatment.
Wound management in burn centres in the United Kingdom
Authors: Papini R P G , Wilson A P R , Steer J A , McGrouther D A , Parkhouse N 
Published: March 2007

Abstract
Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, infection of the burn wound remains a leading cause of morbidity and mortality. The aim of this study was to survey and compare wound management and antibiotic usage in burn surgery in all UK burn centres. A postal questionnaire was used, followed up by telephone. Answers were obtained from all 39 units treating burns in the UK. A written policy on antibiotic usage was used by 13 centres. Excisions were covered routinely by prophylactic antibiotic therapy in 18 units, and three of these used antibiotic cover during all procedures in which the wound was manipulated. No routine antibiotic cover was given in 21 units. All units obtained surface swab cultures, but only two performed punch biopsy of the wounds. Quantitative bacteriology (counting colony forming units) was employed by three centres. Most units cleaned the burn with saline (17 of 39) or chlorhexidine (eight of 39) but combinations of these and other agents were also used. Nearly half (17 of 37) of those who replied had not seen any cases of proven or suspected toxic shock syndrome in the past 2 years. Four units gave prophylaxis against Staphylococcus aureus, and four gave antibiotics against Streptococcus pyogenes, despite recommendations in the literature. Twenty-nine units gave no prophylaxis. This study has revealed that there is no consensus on antibiotic usage amongst centres treating burns in the UK and that most units rely on surface swab cultures to monitor infection.
Aggressive fibromatosis (non-familial desmoid tumour): Therapeutic problems and the role of adjuvant radiotherapy
Authors: Plukker J Th , van Oort I , Vermey A , Molenaar I , Hoekstra H J , Panders A K , Dolsma W V , Koops H Schraffordt 
Published: March 2007

Abstract
Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, even after apparently adequate resection. Wide local excision with a margin of at least 3 cm, depending on the anatomical location, should be performed to improve rates of recurrent disease. There is no consensus concerning the role of radiotherapy in the treatment of these lesions. The clinical findings of 39 cases diagnosed between 1972 and 1991 were reviewed retrospectively. Local control was effected in 19 of 32 patients treated with surgery alone after a median (range) follow-up of 72 (18–236) months. There were 40 cases of recurrent fibromatosis in 15 patients. Local control was obtained in 13 of 14 patients who received radiotherapy using a wide-field technique and doses of more than 50 Gy over a period of 5 weeks after marginal or incomplete resection of primary or recurrent lesions (P &lt; 0.001). The results suggest that in a selected group of patients with aggressive fibromatosis radiotherapy may effectively achieve control of residual disease after surgery without marked disfigurement and loss of function.
Failure of macrophage activation in experimental obstructive jaundice: Association with bacterial translocation
Authors: Reynolds J V , Murchan P , Redmond H P , Watson R W G , Leonard N , Hill A , Clarke P , Marks P , Keane F B V , Tanner W A 
Published: March 2007

Abstract
Bacterial translocation from the gastrointestinal tract and macrophage activation are central to current theories of sepsis. The relevance of both in obstructive jaundice is unclear. The effect of bile duct ligation for 7 days on bacterial translocation to mesenteric lymph nodes and on macrophage activation in a rat model was examined. Compared with an incidence of zero in sham-ligated controls, bile-duct ligated rats had a 67 per cent incidence of Gram-negative colonization of mesenteric lymph nodes. This was associated with a significant (P &lt; 0.001) decrease in macrophage tumour necrosis factor, superoxide anion and nitric oxide production compared with that in sham controls. Spontaneous bacterial translocation occurs in experimental obstructive jaundice and is associated with marked suppression of macrophage activation. This suggests a mechanism whereby jaundiced patients may be more susceptible to persistent infection but relatively protected against uncontrolled sepsis.
Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease
Authors: Makowiec F , Jehle E C , Becker H D , Starlinger M 
Published: March 2007

Abstract
A total of 36 rectal advancement flap repairs were performed in 32 patients with perianal Crohn's disease. There were 12 anovaginal and 20 trans-sphincteric fistulas. Patients were followed prospectively for a mean of 19.5 months to evaluate postoperative recurrence rate. The prognostic influence of fistula type, rectal disease, intestinal disease and faecal diversion on recurrence was assessed. Four of 36 repairs showed primary failure, the operated fistula recurred in 11 patients after a median of 7 months, and a new fistula developed in six patients. The fistula recurrence rate was higher in patients with anovaginal fistula or Crohn's colitis but did not correlate with disease activity. Transitory mild incontinence of stool was observed in one patient only. Although rectal advancement flap repair does not cure perianal fistulas in most patients with Crohn's disease, those without Crohn's colitis may have long-term benefit. Short-term improvement of symptoms justifies this simple procedure even in patients with anovaginal fistula.
Surgical repair of thoracoabdominal aortic aneurysm: 10 years' experience
Authors: Gilling-Smith G L , Worswick L , Knight P F , Wolfe J H N , Mansfield A O 
Published: March 2007

AbstractBetween 1983 and 1993, a total of 110 patients underwent elective repair of thoracoabdominal aortic aneurysm. Mortality rate varied with the extent of repair: 26 per cent (five of 19) after type I repair, 42 per cent (eight of 19) after type II repair, 24 per cent (four of 17) after type III repair and 15 per cent (eight of 55) after type IV repair. A further 20 patients underwent urgent operation for suspected rupture in nine and true rupture in 11. The mortality rate was 73 per cent for those with true rupture and 33 per cent for those with threatened or contained rupture. Death was most commonly due to coagulopathy and bleeding (39 per cent) or myocardial ischaemia (19 per cent). Preoperative risk factors for death included type II repair, urgent or emergency operation, aortic dissection, impaired renal function and abnormal spirometry (P &lt; 0.05). Postoperative risk factors included reoperation, dialysis or prolonged ventilation (P &lt; 0.05). Twenty patients required dialysis; ten died, five recovered normal renal function and five were discharged on dialysis. Eight patients developed paraplegia and four of them died. Thoracoabdominal aneurysm remains a formidable surgical challenge, but 90 per cent of survivors are free of major morbidity.
Endothelial cell ultrastructure after aortic aneurysm rupture: An electron microscopy study
Authors: Milne A A , Bevan B H , Murphy W G , McDougall R D , Bradbury A W , Ruckley C V 
Published: March 2007

Abstract
Endothelial cell activation as an early response to hypovolaemic shock may be important in the pathogenesis of coagulopathy and multiple organ failure after aortic aneurysm rupture. The aim of this study was to determine whether any evidence could be found of changes in endothelial cell ultrastructure in patients undergoing operation for ruptured aneurysm and to establish a model for future studies of endothelial cells in these patients. At the start of operation, fat samples from the anterior abdominal wall were taken from five patients with ruptured abdominal aortic aneurysms and in an identical fashion from five control patients undergoing elective surgery. Endothelial cells lining capillaries were examined by transmission electron microscopy. Photomicrographs were taken of all capillaries present and these were assessed blindly by three independent observers. When compared with controls it was found that the luminal surface of the endothelial cells in patients with aneurysm rupture was more convoluted, with more frequent processes projecting into the lumen of the capillary. Budding of the luminal surface of the endothelial cell was seen in 11 of 45 capillaries in the rupture group and in none of 44 capillaries in the control group (P &lt; 0.005). Budding was seen in at least one capillary of all five patients presenting with rupture but in none of the control group (P &lt; 0.05). In conclusion, at the ultrastructural level there are changes within endothelial cells in capillaries at an early stage after ruptured abdominal aortic aneurysm.
Oesophagoplasty in the treatment of caustic oesophageal strictures in children
Authors: Mutaf O , Özok G , Avanoğlu A 
Published: March 2007

Abstract
A total of 111 children with caustic oesophageal strictures who have subsequently undergone oesophagoplasty were reviewed. Overall 80 patients had a retrosternal colon transplant; a two-stage operation with delayed cervical oesophagocolostomy was the preferred method in 68 of them. Of those having retrosternal surgery two had total necrosis and three had necrosis at the distal end of the transplant. The incidence of cervical anastomotic stenosis was six of 12 in the group undergoing single-stage surgery, compared with seven of 68 in those having the two-stage operation. Ten patients underwent a right thoracic retrohilar colon transplant, seven of whom developed redundancy of the graft. Redundancy was a lesser problem in the retrosternal placement of the transplant. Three patients underwent jejuno-oesophagoplasty which resulted in terminal necrosis in one patient and total necrosis in two. The remaining 18 patients had segmental resection of the intrathoracic oesophageal stenosis followed by end-to-end anastomosis. The overall mortality rate in the series was 3.6 per cent (four of 111).
Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus
Authors: Caldwell M T P , Lawlor P , Byrne P J , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
Bile reflux has been implicated in the pathogenesis of Barrett's oesophagus but evaluation remains difficult. Bilitec 2000 is an ambulatory system that detects bilirubin based on its spectrophotometric properties. Oesophageal bile exposure was evaluated in three groups of patients. Group 1 (n = 11) were normal controls, group 2 (n = 13) were patients with uncomplicated gastro-oesophageal reflux and group 3 (n = 12) were patients with Barrett's oesophagus. Bile reflux was greater in patients with Barrett's mucosa than in controls or those with uncomplicated reflux. This difference was seen in the supine and interdigestive periods. The percentage of time at which gastric pH was greater than 4 and oesophageal pH was above 7 did not differ between the groups. Bilitec 2000 detects greater bile reflux in patients with Barrett's oesophagus. No corresponding gastric or oesophageal alkaline shift is found. This ambulatory bile reflux monitoring system may be a useful tool in clinical practice.
Clinical and experimental studies of intraoperative autotransfusion using a new filtration device
Authors: Varga Z A , Thompson J F , Locke-Edmunds J C , Baird R N , Farndon J R 
Published: March 2007

Abstract
The Haemocell S-350 device has recently been introduced for intraoperative autotransfusion. The system uses a novel membrane filter to process shed blood. In the first part of this study a 0.2-μm pore size filter was used in a randomized trial comparing the use of autotransfusion (n = 8) with bank blood controls (n = 9) during aortic reconstruction. This part of the trial was abandoned because of unexpected non-surgical bleeding. Bank blood requirements fell from a median of 3.0 (range 0.0-9.0) units to 1.5 (range 0.0–7.0) units when autotransfusion was used, but these patients had a greater perioperative blood loss (1791 (range 932–3104) versus 1140 (range 440–3840) ml). There was evidence of postoperative heparin excess with an activated partial thromboplastin time ratio of 1.3 (range 0.9–3.0) versus 1.0 (range 1.0–1.2) in controls and an activated clotting time of 206 (range 143–280) versus 137 (range 107–142) s. This was confirmed by raised plasma heparin levels and a prolonged thrombin time normalized by protamine. To improve performance a 0.6-μm pore size filter was studied in ten patients. Filtration efficiency doubled from 19 to 38 per cent. Electron micrographs demonstrated better filter clearance, but 44 per cent of the original concentration of heparin remained in the reinfusate. The S-350 device may be an attractive alternative to centrifugation for intraoperative autotransfusion but, until efficiency is improved, it should only be used for cardiovascular surgery when excess heparin can be reversed with protamine.
War injuries of the crural arteries
Authors: Radonic V , Baric D , Petricevic A , Kovacevic H , Sapunar D , Glavina-Durdov M 
Published: March 2007

Abstract
Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3–47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.
Comparison between resectable gastric adenocarcinomas seropositive and seronegative for Helicobacter pylori
Authors: Lee W-J , Lin J-T , Shun C-T , Lee W-C , Yu S-C , Lee P-H , Chang K-J , Wei T-C , Chen K-M 
Published: March 2007

Abstract
The preoperative seropositivity of Helicobacter pylori was determined in 128 patients who had undergone gastrectomy for primary gastric adenocarcinoma during the past 5 years. The overall seroprevalence of H. pylori was 64 per cent. Gastric cancers positive for H. pylori were associated with tumours located in the lower third of the stomach which were of localized type (Borrmann I and II) (P &lt; 0.05), but not with age, sex, blood type, tumour size, invasion depth, lymph node metastases, histological type, DNA ploidy or type of surgery. The cumulative 5-year survival curves after surgical resection were significantly better in patients who were positive for H. pylori. Multivariate analysis revealed that seropositivity for H. pylori was not an independent prognostic factor. Pathological tumour node metastasis staging was the only prognostic indicator. Better prognosis for those with H. pylori-seropositive gastric cancer may be attributed to the more advanced stage of H. pylori-seronegative gastric cancers. The potential role of H. pylori in gastric cancer carcinogenesis and its biological significance warrant further investigation.
Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis
Authors: Gurtner G C , Robertson C S , Chung S C S , Ling T K W , Ip S M , Li A K C 
Published: March 2007

Abstract
Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteraemia. This study examines the effect of carbon dioxide pneumoperitoneum on bacteraemia, endotoxaemia and physiological correlates of sepsis in an animal model of peritonitis. New Zealand white rabbits were assigned to three groups of six animals. Group 1 received an intraperitoneal inoculation of 109 colony-forming units of Escherichia coli followed by a 10-cm midline laparotomy. Group 2 received an identical bacterial inoculum followed by a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Group 3 received no bacteria but had a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Groups 1 and 2 had significantly higher levels of bacteraemia (P &lt; 0.01) and endotoxaemia (P &lt; 0.01) accompanied by significantly lower mean arterial pressures (P &lt; 0.05) and higher heart rates (P &lt; 0.05) compared with group 3. After 6 h groups 1 and 2 were significantly hypocarbic (P &lt; 0.01), leucopenic (P &lt; 0.01) and thrombocytopenic (P &lt; 0.01). There was no difference between group 1 and group 2. A carbon dioxide pneumoperitoneum of 12 mmHg does not increase bacteraemia or endotoxaemia, nor does it adversely affect physiological or laboratory correlates of sepsis compared with laparotomy in this animal model of peritonitis.
Seton treatment of perianal fistula with high anal or rectal opening
Authors: Van Tets W F , Kuijpers J H C 
Published: March 2007

Abstract
Staged fistulotomy with a seton is considered to decrease the high incidence of continence disorders after surgical incision of a fistula. This retrospective study reports the results of the two-stage procedure with special emphasis on faecal continence. Thirty-four patients (aged between 20 and 57 years) were treated between 1981 and 1990 with a two-stage seton procedure for anal fistula (16 extrasphincteric and 18 trans-sphincteric) with a high anal or rectal internal opening. Thirty-one patients had normal preoperative continence. There were two recurrences. All trans-sphincteric fistulas healed. Twenty-nine patients with preoperative normal faecal control were available for follow-up. Postoperative continence was normal in 12 patients (category A according to Browning and Parks classification2): five patients had no control over flatus (B), 11 were incontinent for liquid stool or flatus (C) and one had continued faecal leakage (D). The two-stage seton technique is not recommended for fistulas with high anal or rectal openings.
Effect of low-dose dopamine on sigmoid colonic intramucosal pH in patients undergoing elective abdominal aortic aneurysm repair
Authors: Soong C V , Halliday M I , Hood J M , Rowlands B J , Barros D'Sa A A B 
Published: March 2007

Abstract
The effect of low-dose dopamine administration on intramucosal pH (pHi) of the sigmoid colon and on postoperative function of various organs in patients undergoing elective abdominal aortic aneurysm repair was examined. Nineteen patients were randomized to two groups; nine received dopamine at a rate of 3 μg per kg per min for 24 h from induction of anaesthesia and ten control patients received fluids without dopamine. pHi was measured with a silicone tonometer and daily samples of blood were taken for measurement of liver transaminase activity, arterial oxygen saturation and creatinine concentration. Mean(s.e.m.) pHi fell to a significantly lower minimum value in those receiving dopamine compared with control patients (6.86(0.10) versus 7.11(0.08), P&lt;0.05). Five of the nine patients given dopamine developed intramucosal acidosis compared with only one of the ten control patients (P = 0.06). After operation the mean(s.e.m.) aspartate transminase concentration in patients given dopamine rose from 33(2) to 80(17) units/1 (P&lt;0.01); in control patients it rose from 32(3) to 59(16) units/1 (P = 0.054). No difference between the groups was observed in the postoperative ratio of arterial oxygen saturation to inspired oxygen fraction or creatinine conceritrations. These results indicate that dopamine has no beneficial effect on bowel mucosal oxygenation and function of the various organs in patients undergoing aortic aneurysm repair.