bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective randomized trial of Nissen fundoplication and Angelchik prosthesis in the surgical treatment of medically refractory gastro-oesophageal reflux disease
Authors: Kmiot W A , Kirby R M , Akinola D , Temple J G 
Published: March 2007

Abstract
Fifty patients with gastro-oesophageal reflux disease refractory to multiple courses of medical therapy were entered into a prospective randomized trial comparing Nissen fundoplication with the Angelchik prosthesis as a primary surgical procedure. The two groups were matched for age, sex, duration of symptoms before surgery, type of medical therapy, pattern of symptom presentation, endoscopic grade of oesophageal inflammation, manometric lower oesophageal pressure and 24-h pH profile. Twenty-five patients were randomized to each of the Nissen fundoplication and Angelchik prosthesis groups. Operation time and hospital stay were similar in both groups. Persistent dysphagia was reported in five of the patients with an Angelchik prosthesis compared with none in the Nissen fundoplication group. Three prostheses were removed because of severe dysphagia while no Nissen fundoplication required revision. No patient with preoperative dysphagia because of stricture reported swallowing difficulties after operation. At clinical assessment at 3, 6, 12 and 24 months after operation, 85–88 per cent of the patients having a Nissen fundoplication were graded Visick 1 or 2 compared with 60–72 per cent of patients in the Angelchik group.
Effective surgical treatment for mammary duct fistula
Authors: Dixon J M , Thompson A M 
Published: March 2007

Abstract
Forty-two patients with 43 mammary duct fistulae, including 23 with a history of at least one previous unsuccessful operation, were treated by excision of the involved duct and fistula alone (15 fistulae) or excision of the fistula combined with total duct excision (28 fistulae). The wounds were closed primarily with antibiotic cover. Two patients had a minor wound infection which settled within 1 month of surgery; one patient developed superficial necrosis of the nipple and one patient required a second operation to excise a discharging sinus. No fistula recurrence has been identified after a median follow-up of 2·5 years. Excision of the involved duct and fistula alone, or excision of the fistula combined with total duct excision performed with antibiotic cover, is probably the treatment of choice for mammary duct fistula.
Subareolar dissection for duct ectasia and periareolar sepsis
Authors: Hartley M N , Benson E A , Stewart J 
Published: March 2007

Abstract
Excision of the major duct system of the breast for symptoms owing to mammary duct ectasia may be curative, but recent reports have been less optimistic. A retrospective study (1978–1990) of 46 women (median age 38 years, range 18–78 years) who underwent subareolar dissection with antibiotic cover for symptoms associated with duct ectasia is presented. Thirty-three women presented without symptoms of overt sepsis (periareolar lump, nipple discharge or nipple retraction). Following subareolar dissection, six developed recurrent symptoms and five required further surgery. Thirteen women presented initially with abscesses. Eight abscesses recurred following incision and drainage, and one developed a mammillary fistula. Following subareolar dissection, six developed recurrent sepsis requiring further surgery.
Seeding of human microvascular endothelial cells onto polytetrafluoroethylene graft material
Authors: Stansby G , Shukla N , Fuller B , Hamilton G 
Published: March 2007

Abstract
Microvascular endothelial cells from human omental samples were isolated and grown. Adhesion to polytetrafluoroethylene vascular graft material was then studied using scanning electron microscopy and adhesion of cells labelled with indium-111. Grafts coated with fibronectin and type I collagen were found to promote the best adhesion of cells at times up to 90 min. A coating of blood clot matrix was less effective but still resulted in a threefold increase in cell adhesion compared with controls.
Impact of duplex scanning on vascular surgical practice
Authors: Renton S , Nicolaides A , Crofton M 
Published: March 2007

Abstract
This review outlines the development of duplex scanning over the past 15 years and its value not only in vascular medicine and surgery but also in the field of transplantation and obstetrics. It is now the first line of investigation of patients with symptomatic carotid bifurcation disease and those with clinically suspected acute deep venous thrombosis. It is also an established method of femoropopliteal and femorodistal arterial graft surveillance, determination of the extent and cause of chronic venous insufficiency, detection of placentat insufficiency and porta systemic shunt patency, early transplant monitoring, as well as of detecting an arterial stenosis suitable for angioplasty. In addition, it is developing into the method of choice for the initial investigation of patients with suspected mesenteric or renal artery stenosis. The accuracy of duplex scanning, avoiding further unnecessary invasive and expensive diagnostic procedures, makes it one of the most cost-effective investigations ever introduced into clinical practice. Also, when used as a screening technique in arterial and venous disease, it selects those patients who need more invasive procedures such as angiography. This helps to reduce waiting lists of patients requiring investigation, and better directs limited resources to treatment rather than investigation.
Malignancy following ureterosigmoidostomy in patients with exstrophy
Authors: Strachan J R , Woodhouse C R J 
Published: March 2007

Abstract
Forty-two patients with exstrophy underwent a urothelial colonic anastomosis. Eight developed a tumour at the ureterocolic anastomosis and in another two patients a malignant lesion occurred in the bladder remnant.
Schistosomiasis of the appendix
Authors: Adebamowo C A , Ladipo J K , Ajao O G , Akang E E U 
Published: March 2007

Abstract
The clinicopathological features of schistosomiasis of the appendix are discussed, based on the clinical presentation, operative findings and morphological changes in the specimens of patients seen in Ibadan between 1980 and 1989. Schistosoma haematobium was implicated as the causal agent of a granulomatous inflammatory reaction with eosinophilia and fibrosis. Intramuscular oviposition was associated with frank acute appendicitis, and serosal involvement resulted in peritoneal adhesions, with ileoileal intussusception in one patient. The actual role of schistosomal infestation as a contributory factor in appendicitis is still open to debate, but the diagnosis must be entertained in patients in the tropics with features of acute appendicitis or recurrent abdominal pain.
Clinical usefulness of polymorphonuclear elastase in predicting the severity of acute pancreatitis: Results of a multicentre study
Authors: Domínguez-Muñoz J E , Carballo F , de La Morena J , García M J , de Diego J M , Rábago L , Simón M A 
Published: March 2007

Abstract
The usefulness and clinical applicability of quantitative plasma polymorphonuclear elastase determinations in the diagnosis of the severity of acute pancreatítis was analysed in a multicentre study and was compared with the usual prognostic systems of Ranson and Osborne et al. The study comprised 182 patients, 154 with a mild episode of acute pancreatitis and 28 with a severe episode, defined by the development of major complications or a fatal outcome. In the severe cases neutrophilic elastase reached significantly higher values than in mild cases (P &lt; 0·001) by the time the patient was admitted (2–12 h after the onset of the disease), reflecting considerable leucocyte activation. The sensitivity and specificity of this test are therefore greater than 90 per cent, with a positive severity predictive value of almost 80 per cent at the time of admission and 97 per cent after 24 h, and a negative predictive value of approximately 98 per cent. In addition to requiring 48 h for evaluation, the usual prognostic systems show a sensitivity of 77-85 per cent, a specificity of 70–77 per cent, a positive predictive value of 40–48 per cent, and a negative predictive value of 92–95 per cent, clearly lower than those obtained with leucocyte elastase. Polymorphonuclear elastase is therefore a very early and reliable marker in the diagnosis of the severity of acute pancreatitis, in addition to being easily adaptable to the routine of any hospital laboratory.
Role of re-resection in early gastric stump carcinoma
Authors: Staël von Holstein C , Eriksson S , Hammar E 
Published: March 2007

Abstract
Between 1971 and 1990, 26 patients were diagnosed as having an early carcinoma in the gastric remnant after ulcer surgery. Three patients with proximal tumour location were operated on with total gastrectomy. The surgical strategy in the remaining patients with tumour adjacent to the anastomosis was re-resection of at least 5–6 cm of the anastomotic area and restoration of gastrointestinal continuity with a Roux-en-Y loop. A margin of at least 2 cm from the carcinoma to the resection line was taken. There was no postoperative mortality. In three cases the preoperative endoscopic and histological judgement of tumour classification and stage was incorrect; when the surgical specimens were examined one patient was found to have advanced carcinoma and in the other two no malignancy could be found. Median follow-up was 15 years (range 3–19 years). During follow-up, six of the re-resected patients developed recurrences, all located in the gastric remnant. Four patients with recurrence underwent reoperation with total gastrectomy, one had exploratory laparotomy and one had no further surgery. No postoperative deaths occurred. Three of the six patients died from gastric carcinoma. We conclude that this surgical strategy failed to prevent local recurrence of an early form of gastric carcinoma, considered to be potentially curable in virtually all cases. Partial resection of the gastric remnant as the treatment of choice in patients with early gastric stump carcinoma cannot be recommended.
Proximal compared with distal adenocarcinoma of the stomach: Differences and consequences
Authors: Rohde H , Bauer P , Stützer H , Heitmann K , Gebbensleben B 
Published: March 2007

Abstract
Interest in leading prognostic determinants of proximal gastric adenocarcinoma (PGA) in comparison with distally located adenocarcinoma (DLA) of the stomach led to an analysis of data from 506 patients with PGA and 484 patients with DLA operated on between 1 April 1982 and 31 October 1984 and participating in a multicentre observational study to validate tumour node metastasis (TNM) stage groupings. The proportion of men with PGA was slightly higher than that of men with DLA (69 versus 63 per cent). Men more often had cardia carcinomas than women (14 versus 9 per cent); 74 per cent of these men but only 43 per cent of the women were &lt; 65 years old. Evaluation of data by a log-linear model indicated a strong partial association (P &lt; 0·001) between age and site; patients younger than 65 years more often had PGA than older patients. Advanced tumour stage and the intestinal type of carcinoma were more frequently seen in the elderly. More than twice as many patients with PGA in comparison with those with DLA (35 versus 15 per cent) had palliative surgery (moderate association, P &lt;0·05). This may have resulted from different stages at different sites; advanced carcinomas (TNM stages IIIb and IV) were more often diagnosed in patients with PGA than in those with DLA (60 versus 38 per cent). Residual tumour left after surgery was associated with deeper infiltration (P &lt; 0·001). No difference between PGA and DLA groups with respect to histological type of carcinoma was established, but residual tumour was more frequently associated with a diffuse type carcinoma (P &lt;0·01). An overall tendency to poorer long-term prognosis in PGA was seen for all TNM stages, with and without residual tumour, except for TNM stage II with residual tumour, even though patients with PGA were younger than those with DLA. These differences in long-term prognosis, however, are based primarily on poorer short-term survival for PGA, particularly for TNM stages Ib and II without residual tumour. A significant risk of surgical management, particularly for early-stage tumours situated in the upper part of the stomach, has therefore been recognized. Surgeons should appreciate the higher surgical mortality rate for patients with PGA when curative treatment requires more risky surgical techniques.
Devascularization following endoscopic sclerotherapy of oesophageal varices: Dangers and difficulties
Authors: Chaudhary A , Aranya R C 
Published: March 2007

Abstract
Twenty-three patients underwent devascularization operations for acute variceal bleeding. All had received endoscopic sclerotherapy, either long-term or just before surgery. The oesophagus and peri-oesophageal tissues showed either oedematous or fibrotic reaction depending on the number and duration of sessions of sclerotherapy. These changes in the oesophagus and surrounding tissues were responsible for intraoperative oesophageal perforation and postoperative anastomotic leaks. To obviate these problems, stapling of the anterior and posterior walls of the stomach was tried and found to be safer than stapled transection of the oesophagus. During follow-up, varices reappeared in over 75 per cent of patients and were managed by further sclerotherapy. Patients who did not receive sclerotherapy had a higher incidence of rebleeding.
Self-dilatation of cervical oesophagogastric anastomotic stricture: A simple and effective technique
Authors: Shad S K , Gupta S , Chattopadhyay T K 
Published: March 2007

Abstract
Anastomotic stricture causing recurrent dysphagia is a serious problem occurring in patients after total oesophagectomy and cervical oesophagogastrostomy. We have developed a technique of self-dilatation of these strictures using a Foley catheter and have effectively managed ten patients. The technique is simple, painless, safe, cost-effective, and, as a domiciliary technique, patient acceptability is high.
Prevalence of abdominal aortic aneurysm in patients with occlusive peripheral vascular disease
Authors: Galland R B , Simmons M J , Torrie E P H 
Published: March 2007

Abstract
Over a 1-year period, 242 patients with peripheral vascular disease underwent abdominal ultrasonography to detect the presence of an abdominal aortic aneurysm. In 34 (14 per cent) an abdominal aortic aneurysm was found; half of these aneurysms were &gt; 4 cm in diameter. In addition, 16 patients had ectatic aortas. Abdominal aortic aneurysms were more common in men than in women (17 versus 8 per cent). Patients with claudication were as likely to have an abdominal aortic aneurysm as those with rest pain or gangrene. The presence of aortoiliac occlusive disease increased the chance of an aneurysm being present (P &lt; 0·02). Patients with occlusive peripheral vascular disease are a high-risk group with regard to the development of an abdominal aortic aneurysm. Patients with proximal occlusive disease represent a subgroup at even higher risk.
Abdominal aortic aneurysm as an incidental finding in abdominal ultrasonography
Authors: Akkersdijk G J M , de Vries A C , Puylaert J B C M 
Published: March 2007

Abstract
The difference between the mortality rate from ruptured abdominal aortic aneurysm (overall mortality rate 85–95 per cent and operative mortality rate 23–63 per cent), and that for elective aneurysm repair (&lt; 5 per cent) is dramatic. Awareness of the existence of an abdominal aortic aneurysm is therefore essential. Of 1800 consecutive patients aged ⩾ 50 years referred for their first abdominal ultrasonography, 113 who had been referred specifically for suspected abdominal aortic aneurysm or vascular screening were excluded. The remaining 1687 patients (693 men and 994 women) form the study group. Apart from the symptom-directed examination, the entire abdomen of every patient was routinely studied by ultrasonography. The definition of an abdominal aortic aneurysm was a local dilatation of the aorta with an anteroposterior diameter &gt; 30 mm or &gt; 1·5 times the anteroposterior diameter of the proximal aorta. In 82 cases (4·9 per cent) an abdominal aortic aneurysm was disclosed; 61 were in men (8·8 per cent) and 21 were in women (2·1 per cent). The prevalence of abdominal aortic aneurysm as an incidental finding in men aged ⩾60 years was 11·4 per cent. In every patient aged ⩾50 years undergoing their first abdominal ultrasonography examination, the aorta should be screened for the presence of an aneurysm.
Transcranial Doppler monitoring during carotid endarterectomy
Authors: Naylor A R , Jenkins A McL , Ruckley C V , Wildsmith J A W , McClure J 
Published: March 2007

Abstract
Transcranial Doppler monitoring of the middle cerebral artery blood flow velocity was used as an adjunct to routine methods of cerebral monitoring in a prospective study of 30 consecutive patients undergoing carotid endarterectomy to investigate whether transcranial Doppler monitoring provided information influencing operative technique. Application of carotid clamps caused a significant fall in middle cerebral artery velocity and there was a linear relationship between middle cerebral artery velocity and internal carotid artery stump pressure. Assuming a stump pressure of &lt; 50 mmHg to be an indication for shunting, this would correspond to a systolic middle cerebral artery velocity of &lt; 42 cm/s and a mean velocity of &lt; 30 cm/s. Transcranial Doppler monitoring immediately identified problems with shunt function and demonstrated a higher frequency of intraoperative embolization than had been anticipated, particularly after shunt insertion and final restoration of flow. With revision of operative technique this phenomenon is rarely encountered now. Two of the 30 patients exhibited a minor neurological deficit on recovery of consciousness, and transcranial Doppler monitoring was able to identify the probable underlying cause in both cases. Unnecessary and potentially hazardous re-exploration was avoided. In the absence of transcranial Doppler monitoring the neurological deficit in one of the patients might have been much worse.
Use of the appendix in reconstructive surgery: A case against incidental appendicectomy
Authors: Wheeler R A , Malone P S 
Published: March 2007

Abstract
Ignored for years, the appendix is once again being promoted as having useful surgical potential, notably in the management of incontinence. Incidental and prophylactic appendicectomy with their established complications become less easy to justify as the incidence of appendicitis declines. The role of the appendix in reconstructive surgery is reviewed, with particular reference to urinary reconstruction and to the treatment of chronically constipated or faecally incontinent children by use of the antegrade continence enema.
Sutureless intestinal anastomoses
Authors: McCue J L , Phillips R K S 
Published: March 2007

Abstract
Sutureless intestinal anastomoses can be achieved either by compression, where two inverted rings of bowel are compressed by a hollow circular device that subsequently sloughs away and is passed anally, or by the use of tissue glues or laser welding. Compression devices used clinically with success are the Valtrac® biofragmentable anastomotic ring, the polypropylene rings described by Rosati and the AKA guns. Glued anastomoses have only been used in animals and seem to be unsafe. However, laser-welded intestinal anastomoses appear highly promising in experimental studies and further development of this technique is warranted.
Abdominal injuries in the war wounded of Afghanistan: A report from the International Committee of the Red Cross Hospital in Kabul
Authors: Morris D S , Sugrue W J 
Published: March 2007

Abstract
This report is from the hospital opened by the International Committee of the Red Cross, in Kabul, which receives acute war-wounded patients from the Afghanistan conflict. Of more than 1000 operations carried out by the New Zealand team in a 6-month period, there were 70 laparotomies for penetrating wounds. These injuries were dealt with by established surgical techniques. The main area of controversy was the management of colonic wounds where the recent trend away from mandatory colostomy was followed by good results. Selective primary repair was achieved in 16 of 27 patients with colonic injury with no mortality and minimal morbidity. The right colon was considered particularly favourable for primary anastomosis. The overall mortality rate for all laparotomies was 13 per cent, with injuries to the liver, major veins and rectum particularly being fatal. There were eight negative laparotomies.
Glutamine-enhanced enteral diet improves nitrogen balance without increasing portal ammonia
Authors: Brown M G , Campbell G R , Rowlands B J 
Published: March 2007

Abstract
Following surgical stress the jejunum actively metabolizes endogenous glutamine, a non-essential amino acid, to produce alanine and ammonia, which augments substrate flow to the liver at a time when oral intake of nutrients is decreased. Oral glutamine supplementation theoretically may modify the response to injury. This study was designed to demonstrate the role of the jejunum in postinjury glutamine metabolism and to evaluate the influence of enteral glutamine supplements on nitrogen and ammonia metabolism after laparotomy and bowel resection in dogs. Oral glutamine in the presence of an intact small bowel significantly improved nitrogen balance (461 mg kg body-weight−1 day−1) compared with a control diet (− 370 mg kg−1 day−1) (P &lt; 0.05, analysis of variance). Removal of the proximal small bowel prevented this beneficial effect of glutamine (− 507 mg kg−1 day−1). Glutamine-supplemented and control diets were associated with similar portal ammonia concentrations throughout the study.
Secondary surgery for liver trauma
Authors: Sherlock D J , Bismuth H 
Published: March 2007

Abstract
Over a 10-year period from 1980, 46 patients with liver injuries were referred after primary admission to other hospitals. Previous surgery had been performed in 40 cases and the predominant reasons for referral were uncontrollable bleeding and postoperative sepsis with biliary leakage. Of 30 such cases, 19 were treated by liver resection; all were of a limited nature and no major hepatectomies were performed. Only two deaths occurred in these patients and this low mortality rate supports our conservative approach to liver trauma. Other reasons for referral were late biliary stenosis, complicated penetrating injury and intrahepatic haematoma. Three cases were referred with postoperative hepatic failure; two responded to resection of infected necrotic tissue and liver transplantation was attempted in the third. Injuries to liver segments 6 and 7 were those most frequently referred for assistance with bleeding, and all patients were safely transferred after intra-abdominal packing. This injury is particularly suitable for resection by segmentectomy rather than a formal hepatectomy, which has been associated with a high mortality rate in trauma cases. Further patients with intractable injuries might be salvaged by liver transplantation.