bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of harvesting methods for islet transplantation
Authors: Griffin S M , Alderson D , Farndon J R 
Published: March 2007

Abstract
One problem preventing islet transplantation becoming a clinical reality in the treatment of insulin-dependent diabetes is the unsatisfactory, low yield processes for harvesting islets. This study was designed to find the most effective harvesting process and to examine the feasibility of obtaining more than one graft from a single pancreas. After confirming that normoglycaemia at one month could be achieved in dogs using 50 per cent of an autograft prepared by a previously established method, novel techniques were assessed using 33 per cent of the tissue obtained. An isolation process involving perfusion of the duct by enzymes allowed normoglycaemia using only one-third of the graft preparation and these animals exhibited significantly improved glucose handling and insulin output when compared with recipients of grafts prepared by the established method. A significant improvement in harvesting technique has, therefore, been demonstrated and this will exploit the potential of multiple donor grafts in islet transplantation and the method may be worthy of trial in the human gland.
Hyperalimentation of jaundiced patients on percutaneous transhepatic biliary drainage
Authors: Foschi D , Cavagna G , Callioni F , Morandi E , Rovati V 
Published: March 2007

Abstract
Although percutaneous transhepatic biliary drainage (PTBD) restores hepatic and renal function in patients with obstructive jaundice, it is not certain whether it reduces the rate of complications and death after biliopancreatic surgery. We studied the possibility that the operative risks of jaundiced patients are related to malnutrition and the usefulness of hyperalimentation with PTBD to reduce the incidence of complications. Sixty-four patients with obstructive jaundice and serum bilirubin &gt; 200 μmol/l were randomized into two treatment groups (n = 32) with PTBD or PTBD + hyperalimentation. Four patients were withdrawn from the latter group, two for metastatic cancer and two for complications of PTBD. Before starting hyperalimentation, the incidence of malnutrition was assessed by biochemical, immunological and anthropometric tests: malnutrition was found in 70 per cent of the patients. All the patients had good recovery of hepatic function but patients treated with PTBD alone still had high mortality (12.5 per cent) and morbidity (46.8 per cent) after biliopancreatic surgery. When hyperalimentation was provided to patients on PTBD for a period of 20 days before the operation, the incidence of complications fell to 17.8 per cent and mortality to 3.5 per cent. These results suggest that the combined use of PTBD and hyperalimentation, improving both hepatic function tests and the nutritional status of jaundiced patients, can reduce the rate of complications after biliary and pancreatic surgery.
Determinants of survival in liver resection for colorectal secondaries
Authors: Ekberg H , Tranberg K-G , Andersson R , Lundstedt C , Hägerstrand I , Ranstam J , Bengmark S 
Published: March 2007

Abstract
All 72 resections for colorectal liver secondaries during the period 1971–1984 were analysed retrospectively. Liver tumours were single in 35 (49 per cent), unilateral in 55 (76 per cent) and associated with extrahepatic disease in 12 (18 per cent) patients. Operative mortality was 5.6 per cent. With respect to the disease in the liver, the presence or absence of four or more metastases was the predominant prognostic determinant with a 5 year survival rate of 20 per cent in patients with less than four liver tumours, and no 3 year survivor among patients with four or more tumours. When the number of liver tumours was less than four, the prognosis in patients with unilateral disease was not significantly better than in patients with bilateral disease (P = 0.19). No other liver disease variable seemed to play any role in the prognosis. Extrahepatic disease was associated with a poor prognosis and no 5 year survivor. The length of the tumour-free resection margin was the only treatment variable that varied with the outcome: a resection margin of &lt; 10 mm was followed by a poor survival. Variables that did not influence survival included uni- or bilateral disease, liver tumour volume, tumour size, type of liver resection, Dukes' classification, differentiation of the primary tumour and synchronous or metachronous disease. It is concluded that resection for liver colorectal secondaries is indicated when (a) there are less than four liver tumours, even if bilateral, (b) no extrahepatic disease is present, and (c) a resection margin of at least 10 mm can be obtained. It should not be performed unless all of these requirements are met.
The use of CA-50 radioimmunoassay inhibition test in the differential diagnosis of benign and malignant liver diseases
Authors: Habib N A , Hershman M J , Smadja C , Wood C B 
Published: March 2007

Abstract
The value of a radioimmunoassay (RIA) in the detection of the human carcinoma-associated antigen CA-50 has been assessed in 50 normal subjects, 28 patients with various benign liver diseases and 91 patients with primary and secondary liver carcinomas. Sera from all normal subjects and 25 of 28 (89 per cent) patients with benign liver diseases had a CA-50 level below 17 units/ml. Three patients with sclerosing cholangitis and sixty (66 per cent) patients with primary or secondary liver tumours had CA-50 levels above 17 units/ml. CA-50 may therefore be a useful tumour marker for the diagnosis of liver carcinomas and for the post-treatment monitoring of patients with various liver malignancies.
Fibrin adhesive versus sutured anastomosis: A comparative intra-individual study in the small intestine of pigs
Authors: Hjortrup A , Nordkild P , Kiærgaard J , Sjøntoft E , Olesen H P 
Published: March 2007

Abstract
The small intestine in each of ten pigs was subjected to three anastomoses: one sutured anastomosis and two non-suture fibrin adhesive anastomoses in an intra-individual controlled comparison. There was no significant difference in the in vivo bursting strength after 7 days. Thus, the two types of anastomoses were of equal strength. It is concluded that it appears possible to achieve a safe sutureless anastomosis in the small intestine, with fibrin adhesive alone.
Somatostatin in the treatment of severe upper gastrointestinal bleeding: A multicentre controlled trial
Authors: Torres A J , Landa I , Hernández F , Jover J M , Suárez A , Arias J , Cuberes Rosa , Santoyo J , Fernández Rosa , Calleja J , Nisa Elena , Rodriguez J L , Moreno E , Balibrea J L 
Published: March 2007

Abstract
To evaluate the effectiveness of somatostatin versus combined cimetidine and pirenzepine in the treatment of upper gastrointestinal (GI) bleeding of peptic origin, a multicentre controlled, prospective, randomized and double blind trial has been undertaken in 60 subjects. Strict selection criteria were followed. All subjects were diagnosed by endoscopy during the first 18 h after admission. Endoscopic stigmata of recent haemorrhage were also evaluated. Sixty-five per cent of the subjects presented with severe upper GI bleeding (blood pressure ⩽ 100 mmHg, pulse rate ⩾ 110, haematocrit ⩽ 30 per cent), and in 71·6 per cent stigmata were found. Thirty patients (Group 1) received a somatostatin infusion (250 μ/h continuously during 120 h) and 30 patients (Group 2) received cimetidine (200 mg IV every 4 h for 5 days) and pirenzepine (10 mg IV every 8 h for 5 days). Both groups were homogeneous for sex, age, backgrounds, bleeding source, grade of bleeding (moderate or severe) and presence or not of stigmata. Bleeding stopped in 27 subjects of Group 1 (90 per cent and in 20 subjects of Group 2 (66·67 per cent) (P &lt; 0·05, χ2 test). The time until the bleeding stopped was significantly shorter in patients of group 1 (3·44 ± 0·53 h) than in patients of group 2 (8·12 ± 1·94 h) (P &lt; 0·05, Mann–Whitney U test). The number of blood units required for Group 1 (2·26 ± 0·35) was significantly lower than the one required for Group 2 (3·90 ± 0·51) (P &lt; 0·005, Wilcoxon test). Significant differences were not observed between the two groups regarding cross-over subjects, rebleeding, surgery (P = 0·0635, Fisher's exact test) and hospital stay. The mortality of the trial was 5 per cent. There was no toxicity during somatostatin, cimetidine or pirenzepine infusion. In conclusion, somatostatin was more effective than cimetidine plus pirenzepine in the control of severe upper GI bleeding of peptic origin, with a lower interval time to stop bleeding and reduced transfusion requirements.
Doppler ultrasound as an adjunct to the differential diagnosis of pigmented skin lesions
Authors: Srivastava A , Hughes B R , Hughes L E , Woodcock J P 
Published: March 2007

Abstract
One hundred and forty-one pigmented skin tumours were examined with a 10 MHz ultrasound Doppler flowmeter to investigate the value of detecting blood flow in the diagnosis of raised pigmented skin lesions. Most of the benign lesions except for those with an angiomatous basis were devoid of blood flow signals while all basal cell carcinomas and 96 per cent of thick melanomas (⩾ 0·9 mm) were associated with detectable Doppler frequency shift signals. While the characteristics of analysed Doppler waveforms are of research interest, the simple detection of blood flow by a hand held instrument gives sufficient information for clinical purposes. In practice this simple test has been sufficiently reliable to prove a useful adjunct in the diagnosis of raised pigmented skin lesions. It has been found particularly helpful in the common clinical problem of differentiation of nodular melanoma from basal cell papilloma and benign intradermal naevus. If such a lesion is thought to be benign, and has detectable flow signals, one should reconsider the diagnosis. Absence of flow signals is strong confirmation of a benign clinical diagnosis. The test should be regarded as an adjunct to clinical diagnosis since, in common with all non-invasive diagnostic techniques, false negative and false positive cases will be encountered. The technique is not appropriate to macular lesions since these are usually flow negative, irrespective of the pathology.
Surgery for malignant melanoma: From which limb should the graft be taken?
Authors: Flook D , Horgan K , Taylor B A , Hughes L E 
Published: March 2007

Abstract
A study of 186 melanomas requiring skin grafts and followed for 1–13 years has shown no preferential implantation in an ipsilateral donor site, despite standard surgical teaching that skin grafts for melanoma defects should not be taken from the same limb as the primary tumour. Two cases were encountered of preferential metastasis to a distant donor site outside the lymphatic drainage of the melanoma and we present a further case where ipsilateral recurrence simulated donor site recurrence. It is clear that the major mechanism of spread to distant donor sites is by the haematogenous route to an area of acute trauma. Hence it is recommended that where possible donor skin is taken from the same limb as the tumour, so that any preferential metastasis will remain within an area amenable to regional limb perfusion.
Early gastric cancer
Authors: Oleagoitia J M , Echevarria A , Santidrian J I , Ulacia M A , Hernandez-Calvo J 
Published: March 2007

Abstract
From 1975 to 1985, 142 patients with early gastric cancer were operated on in our service; this group comprised 14 per cent of all patients with gastric cancer operated on during this period. Epigastric pain was the most frequent symptom (75·3 per cent). The lesions were located in the lower third in 45·8 per cent, in the middle third in 31·7 per cent, in the upper third in 20·4 per cent and in the gastric stump in 2·1 per cent. Subtotal gastrectomy was performed in 116 patients and operative mortality was limited to two patients. Macroscopically 86·6 per cent of cases were included in type III, IIc and IIc–III. The five year survival rate, excluding the operative mortality, was 93·1 per cent. Tumours located in the lower third of the stomach, limited to the mucosa and of ulcerating type, had the best prognosis.
Survival of surgical patients with carcinoma, lymphoma and carcinoid tumours of the small bowel
Authors: Taggart D P , McLatchie G R , Imrie C W 
Published: March 2007

Abstract
We have analysed the effects of ‘curative’ and palliative surgery and adjuvant therapy on actuarial 5 and 10 year survival in 97 local patients with primary small bowel malignancies presenting to five Glasgow teaching hospitals over a 15 year period. The 5 year survival rates in 18 patients with lymphoma undergoing ‘curative’ surgery was 48 per cent while in patients whose surgery was considered palliative the figure was 12 per cent (P &lt; 0·001). In the 29 patients with carcinoma, 17 had ‘curative’ surgery and 12 a palliative procedure with respective 5 year survival rates of 38 per cent and 0 per cent (P &lt; 0·07). In 16 patients with carcinoid tumours the surgeons' assessment of curative or palliative surgery was of little consequence with 51 per cent of the palliative group alive at 10 years. Mean survivals were increased in lymphoma patients in both ‘curative’ and palliative groups receiving adjuvant therapy but not significantly so. We suggest that all detectable macroscopic tumour, where possible, should be removed and that adjuvant therapy may be of benefit in all patients with lymphoma, even when surgery is considered ‘curative’.
Clinical and radiographic features of simple and hydatid cysts of the liver
Authors: Harris K M , Morris D L , Tudor R , Toghill P , Hardcastle J D 
Published: March 2007

Abstract
The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.
Immunorestorative effect of lipid emulsions during total parenteral nutrition
Authors: Monson J R T , Ramsden Carol W , MacFie J , Brennan T G , Guillou P J 
Published: March 2007

Abstract
This prospective in vivo cross-over study investigated the effect of Intralipid on immune responses. Twenty-three patients were randomly allocated to receive one of two alternative total parenteral nutrition (TPN) regimens for the first 7 days and the other regimen for the second 7 days. Only one of the regimens included a fat emulsion to provide 50 per cent of the calorific requirement. Immunological studies were performed on days 0, 7 and 14. These included peripheral blood T cell subsets, antibody dependent cellular cytotoxicity and basal and maximal Interleukin 2 production. All immunological parameters were significantly augmented during total parenteral nutrition using the lipid based regimen. No such change was seen during intravenous feeding with carbohydrate based TPN. It is concluded that, far from being immunosuppressive, the incorporation of a fat emulsion into a TPN regimen has immunostimulatory properties.
Direct arterial pressure measurements during operation to assess adequacy of arterial reconstruction in lower limb ischaemia
Authors: Tweedie J H , Ballantyne K C , Callum K G 
Published: March 2007

Abstract
Over a 3-year period 164 patients undergoing arterial reconstruction for lower limb ischaemia had direct arterial pressure measurements during the operation. The arterial pressure was measured by direct puncture of the vessel with a No. 23 gauge needle connected, via a cannula, to a pressure transducer. The pressure was measured proximal and distal to anastomoses or endarterectomies, and note was made both of the absolute pressure and waveform. At 3 months 95 per cent were patent. In nine patients (5 per cent), there was a significant fall of pressure across the reconstructed artery and in eight of these procedures were carried out to correct the fault. The technique of direct arterial pressure measurement is quick and easy to perform, with equipment that is used routinely for monitoring by the anaesthetist. There has been no evidence of damage due to the arterial puncture itself. It provides a simple, objective assessment of adequacy of an arterial reconstruction and may lead to the early correction of otherwise unrecognized faults, and thus prevent early graft occlusion.
Indications for thoracotomy in stab injuries of the chest: A prospective study of 543 patients
Authors: Demetriades D , Rabinowitz B , Markides N 
Published: March 2007

Abstract
This is a prospective study of 543 patients with stab wounds of the chest treated in a 15 month period. Four hundred and sixty-seven patients (86 per cent) were selected for conservative treatment with no mortality. Of the 76 patients in the operatively treated group 68 were operated on in the operating theatre with a mortality of 17 per cent, while the remaining eight had a thoracotomy in the resuscitation room with a mortality of 87.5 per cent. Indications for early operation would appear to be the presence of signs of cardiac or major vascular injury (i.e. tamponade, profuse bleeding, an absent or diminished peripheral pulse, and shock not responding to aggressive resuscitation). A cautious digital exploration of the chest wound may help identify these injuries by obtaining information about the knife tract (towards or away from the heart or major vessels). The presence of shock on admission should not be an absolute indication for operation. Half the 156 patients with shock on admission were treated conservatively with no mortality. The presence of a wound over the precordium is not in itself an absolute indication for surgery. Seventy-two such patients, including 14 with shock, were successfully treated non-operatively. Massive air leaks are usually self-controlled and none of the 24 such cases required operation. The amount or rate of blood loss via the thoracotomy tube is not a reliable index of the severity of the injury and it should not be a sole criterion for the selection of the type of treatment.
Selective cefuroxime prophylaxis following colorectal surgery based on intra-operative dipslide culture
Authors: Claesson B E B , Filipsson S , Holmlund D E W , Mätzsch T W , Wählby L 
Published: March 2007

Abstract
The concept of a very limited effective period for prophylactic antibiotic action was challenged in a prospective, controlled and randomized study featuring a simplified method for assessing the degree of contamination in the operative field during colorectal surgery. The 226 patients were given 1 g metronidazole IV on induction of anaesthesia and 12 h postoperatively. Following standardized saline irrigation of the abdominal cavity, a uriculture dipslide was dipped in the residual fluid just before abdominal closure. The dipslide was incubated for 18 h, and colony counts of coliforms and Staphylococcus aureus were made. The number of colony-forming units (CFU) was classified as 0, 1–4 or ⩾ 5 (n = 123, 33 and 70). The patients with CFU ⩾ 5 were randomized to receive cefuroxime (1·5 g IV/8 h for 2 days) or no more antibiotics. In the patients given only metronidazole, the incidence of postoperative infections rose with the colony counts (5·7, 9·1 and 41·2 per cent with CFU 0, 1–4 and ⩾ 5). Addition of cefuroxime reduced the 41·2 per cent infection rate to 8·3 per cent (P = 0·003). The method thus identified a high-risk group in which a short postoperative course of cefuroxime significantly lowered the rate of sepsis.
In vitro binding and in vivo localization in colorectal cancer of a high affinity monoclonal antibody to carcinoembryonic antigen
Authors: Armitage N C , Perkins A C , Durrant L G , Ellis I O , Ballantyne K C , Harrison R C , Riley A M L , Robins R A , Wastie M L , Hardcastle J D 
Published: March 2007

Abstract
A monoclonal antibody to carcinoembryonic antigen (CEA) (C46) was tested for its binding properties to colorectal cancer cells in vitro and for its localization in patients with primary colorectal cancer. Strong binding was found to disaggregated primary colorectal cancer cells, with a median of 66 per cent of the cells in the tumour gate binding the antibody. There was a median binding ratio of 8·6:1 compared with normal immunoglobulin. The pattern of immunohistological staining was typical of that for an antibody to CEA. All seven patients with primary colorectal cancer imaged pre-operatively using 111In-labelled C46 gave positive images. The median tumour:non-tumour antibody uptake ratio from resected specimens (n = 8) was 5·8:1. (1·7–7·6:1). Eight of 11 sites of secondary colorectal cancer gave positive images. The high affinity and good tumour localization of C46 have improved clinical imaging and increase the possibilities for targetting of antitumour agents.
Effect of perioperative blood transfusion on recurrence of colorectal cancer
Authors: Parrott N R , Lennard T W J , Taylor R M R , Proud G , Shenton B K , Johnston I D A 
Published: March 2007

Abstract
The aim of the present study was to examine the outcome of 517 patients undergoing curative surgery for colonic and rectal cancer, and to compare the recurrence and mortality rates in transfused and non-transfused groups of patients. The two groups were evenly matched for age, sex, Dukes' stage and histological differentiation. There were significantly more rectal tumours in the transfused group (P &lt; 0·01), but the distribution of colonic lesions did not differ. Life table analysis revealed that the transfused patients had a 20 per cent greater probability of recurrence at 5 years (P &lt; 0·005) and there were 16 per cent more cancer related deaths (P &lt; 0·01). Even when all rectal cancers were excluded, a similar trend was seen for the colonic lesions: a 24 per cent greater probability of recurrence at 5 years (P &lt; 0·025) and 15 per cent more cancer related deaths (P &lt; 0·02). We conclude that blood transfusion may be associated with increased mortality and recurrence in patients undergoing curative surgery for colorectal cancer.
Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form
Authors: Brown S C W , Kazzazi N , Lord P H 
Published: March 2007

Abstract
Severe cases of hidradenitis suppurativa affecting the perineum and gluteal regions may be treated successfully by ‘deroofing’ the sinus and fistulae tracts. These lie in the dermis and are partly epithelialized by cells from involved hair follicles and disrupted sweat glands. Careful preservation of the floor of the tracts leads to re-epithelialization with disease-free skin. More radical surgery is unnecessary and the problems of covering widely excised areas in this heavily contaminated region are avoided. By spreading the treatment over several operating sessions and hospital admissions, postoperative discomfort and in-patient nursing requirements are minimized. The technique of deroofing is described and the treatment of three severe cases is discussed. One patient illustrated the recognized complication of malignant change occurring in long-standing untreated disease. A fourth case illustrates the difficulties in diagnosing perianal hidradenitis suppurativa and literature cited suggests it to be a more common condition than once thought and a diagnosis frequently missed.