bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal anal sphincter dysfunction in neurogenic faecal incontinence
Authors: Farouk R , Duthie G S , Pryde A , McGregor A B , Bartolo D C C 
Published: March 2007

Abstract
Forty-eight patients of median age 57 years with neurogenic faecal incontinence and 44 normal subjects of median age 51 years underwent fine-wire anal sphincter electromyography and anal manometry. The median (interquartile range (i.q.r.)) internal anal sphincter (IAS) electromyogram frequency was 0·26 (0·21–0·32) Hz for patients with faecal incontinence and 0·44 (0·31–0·55) Hz for controls (P &lt; 0·01). The median (i.q.r.) ambulatory resting pressure was 48 (34–68) cmH2O for patients and 86 (72–102) cmH2O for controls (P &lt; 0·01) and median (i.q.r.) frequency of transient IAS relaxations 9 (7–12) and 4 (3–7) per h respectively (P &lt; 0·05). Mid-anal pressure fell to a greater extent in patients with incontinence during these episodes of transient IAS relaxation. Rectal pressure during such relaxation did not exceed mid-anal canal pressure in controls; for the patient group. rectal pressure increased during relaxation and exceeded mid-anal canal pressure in 36 cases. Frequent abnormal episodes of IAS relaxation may cause occult faecal leakage in patients with neurogenic faecal incontinence.
Intra-abdominal photodynamic therapy: From theory to feasibility
Authors: Evrard S , Aprahamian M , Marescaux J 
Published: March 2007

Abstract
Photodynamic therapy is a new anticancer technique, directed at the selective destruction of neoplastic tissue, which has been used in the treatment of superficial or intraluminal lesions. The technique has now reached the stage where it can be considered in the peroperative management of gastrointestinal tumours, for example in an attempt to eradicate micrometastases in the tissue around the primary tumour or in residual lymph nodes after curative resection. Many practical problems remain to be solved, such as the pharmacokinetics of photosensitizers, the dosimetry of illumination and the sensitivity of intra-abdominal organs. An experimental and clinical evaluation is in progress to assess the feasibility of photodynamic therapy in surgical practice.
High incidence of arteriovenous fistula after biopsy of kidney allografts
Authors: Merkus J W S , Zeebregts C J A M , Hoitsma A J , van Asten W N J C , Koene R A P , Skotnicki S H 
Published: March 2007

Abstract
Arteriovenous fistula (AVF) is a well known but rarely diagnosed complication of percutaneous biopsy of kidney allografts. In the past diagnosis was usually made when clinical signs of an AVF occurred but Doppler ultrasonography has now enabled non-invasive diagnosis. Doppler examination of kidney allografts was performed after 100 biopsies. A total of ten AVFs were diagnosed within 2 weeks of biopsy. On repeated examination 2 months later, no additional fistula was detected. All fistulas were detected by abnormal colour shading of the artery and vein of the fistula caused by high blood velocity. Quantification in the artery supplying the fistula showed a higher systolic velocity compared with that in a normal artery of comparable size and location in the graft (mean (range) 64 (25–150) versus 36 (20–65) cm/s, P &lt;0.05). Diastolic velocity was also higher in the artery supplying the fistula than in a normal artery (mean (range) 34 (9–72) versus 7 (0–13) cm/s, P &lt;0.05). In the group with an AVF the proportion with a prolonged bleeding time (&gt;3 min) was higher (80 versus 47 per cent, P &lt; 0.05), as was the prevalence of a platelet count &lt; 200 × 109/l (60 versus 22 per cent, P &lt; 0.05). After detection of the fistula, four of the grafts were lost because of rejection and two patients died from sepsis during antirejection treatment. During follow-up of the remaining four AVFs three disappeared spontaneously and one persisted. None of the fistulas has had an impact on renal function requiring intervention. In conclusion, AVF is a complication observed frequently after kidney allograft biopsy that can be detected and monitored by Doppler ultrasonography.
Autologous predonation, haemodilution and intraoperative blood salvage in elective abdominal aortic aneurysm repair
Authors: Tulloh B R , Brakespear C P , Bates S C , Adams D C R , Dalton R G , Richards M J , Durkin M A , Bristol J B , Poskitt K R 
Published: March 2007

Abstract
The feasibility of predonated autologous blood transfusion and intraoperative blood salvage in elective abdominal aortic aneurysm repair was studied. Twenty consecutive patients were evaluated, of whom five were excluded according to protocol criteria. Patients each donated 1 unit blood 14 and 7 days before operation. A third unit was withdrawn in the anaesthetic room and replaced with Hartmann's solution, producing a haemodiluted state. Intraoperative losses were minimized using the Haemonetics Cell Saver III Plus autotransfusion system. Predonated blood from two patients passed its expiry date owing to repeated operation postponements, leaving 13 patients for study. The mean(s.d.) intraoperative blood loss was 700(300) ml with a mean(s.d.) intraoperative salvage of 420 (300) ml. Two patients were transfused with bank blood in breach of the protocol and two others were transfused according to clinical need. Thus nine patients safely avoided homologous transfusion. With autologous predonation, haemodilution and intraoperative blood salvage, elective aortic aneurysm repair can be performed safely with minimal need for homologous blood.
Surgical treatment of reflux stricture of the oesophagus
Authors: Bonavina L , Fontebasso V , Bardini R , Baessato M , Peracchia A 
Published: March 2007

Abstract
The choice of surgery in patients with reflux-induced oesophageal stricture remains controversial. From 1976 to 1990, a total of 65 patients underwent fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten), total duodenal diversion (four) and oesophageal resection (15). The postoperative mortality rate was 5 per cent (three patients): necrosis of the colon transplant in two patients and acute pancreatitis in one. The median follow-up was 25 (range 6–120) months. After conservative surgery, the median number of dilatations per patient per year significantly decreased (P &lt;0.001). Nine patients (25 per cent) complained of persistent or recurrent symptoms after standard fundoplication and six required reoperation. Clinical results were satisfactory in patients who underwent Collis fundoplication, total duodenal diversion and oesophageal resection. It is concluded that the causes of failed fundoplication are irreversible stricture or persistent gastro-oesophageal reflux; the latter may be caused by inefficacy or deterioration of the partial fundoplication wrap. A subtle degree of oesophageal shortening is probably underestimated in such patients and this may explain the better results obtained with the Collis fundoplication. Total duodenal diversion is a good therapeutic option in patients who have undergone previous oesophagogastric surgery. Oesophageal resection should be reserved for patients with tight strictures unresponsive to dilatation or those with scleroderma, multiple previous operations or severe dysplasia in Barrett's oesophagus.
Monofilament versus multifilament absorbable sutures for abdominal closure
Authors: Sahlin S , Ahlberg J , Granström L , Ljungström K-G 
Published: March 2007

Abstract
This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal ineision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P &lt;0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.
Early gastric cancer: Follow-up after gastrectomy in 159 patients
Authors: Guadagni S , Reed P I , Johnston B J , De Bernardinis G , Catarci M , Valenti M , Di Orio2 F , Carboni M 
Published: March 2007

Abstract
The postoperative course of 159 patients with early gastric cancer operated on between 1974 and 1987 was followed for a median of 7.3 years. The cumulative 10-year survival rate(s.e.) calculated using follow-up data to the end of 1989 was 90.6(2.7) per cent excluding operative death and that from causes other than gastric cancer, or 86.3(3.0) per cent when operative mortality was included. The overall 10-year survival rate(s.e.) was 77.3(3.7) per cent. Univariate analysis showed a significant difference in survival rates between cancers confined to the mucosa and those with submucosal invasion (P = 0.02), between patients with and without lymph node metastases (P = 0.05) and between those &gt;50 and &gt;50 years of age (P = 0.02). Using Cox multivariate analysis and a stepwise procedure for eight variables (sex, age, depth of invasion, lymph node metastases, presence of ulceration, location, histological type, type of surgery), age and histological type had the most significant effect on survival. Seven operative deaths were recorded. Eleven patients died from recurrent cancer and one is still alive with a gastric remnant recurrence. Other causes of death were metachronous primary cancer (six patients), cardiovascular disease (two), pneumonia (three), sepsis (one) and car accident (one). Although the prognosis of early gastric cancer is relatively good in western countries, patients should be carefully followed over a long period for late recurrence and for metachronous cancer, which has a high incidence.
Photoplethysmography in the diagnosis of superficial venous valvular incompetence
Authors: Rutgers P H , Kitslaar P J E H M , Ermers E J M 
Published: March 2007

Abstract
Photoplethysmography was compared with clinical investigation combined with Doppler ultrasonography in the diagnosis of superficial venous valvular incompetence of the lower limb. In 268 consecutive patients, 536 limbs were investigated. A total of 22.I per cent of the photoplethysmographic investigations were uninterpretable because they did not allow reliable determination of the refilling time. Agreement between clinical investigation combined with Doppler ultrasonography and photoplethysmography was found to be poor (K = 0.30). These results suggest that photoplethysmography is not the non-invasive method of choice for routine evaluation of superficial venous valvuular incompetence of the leg.
Cardiac risk and peripheral vascular surgery: New approach based on a multifactorial risk index
Authors: Jivegård L , Frid I , Haljamäe H , Hallenberg B , Holm J , Johansson S R 
Published: March 2007

Abstract
An inexpensive approach to stratification of patients admitted for arterial surgery into groups of high and low cardiac risk has been prospectively evaluated in 235 consecutive patients. The Goldman and Detsky indices, assessed by a nurse the day before surgery, both identified patient groups with increased risk of lethal or potentially lethal (myocardial infarction, pulmonary oedema) cardiac events within 30 days after peripheral vascular surgery. The Goldman index was the more sensitive predictor of cardiac death (overall frequency 3.1 per cent) while the Detsky index was superior for prediction of non-lethal cardiac events (overall frequency 5.9 per cent). The simplest and yet most effective stratification into high and low cardiac risk was achieved using a Detsky score of 10 as the cut-off. It is concluded that multifactorial risk index-based preoperative screening can identify low-risk patients (Detsky score ⩽ 10), who may be accepted for vascular surgery (aortic aneurysm surgery excluded) without additional cardiac testing.
Effect of seeding time and density on endothelial cell attachment to damaged vascular surfaces
Authors: Thompson M M , Budd J S , Eady S L , Allen K E , James M , James R F L , Bell P R F 
Published: March 2007

Abstract
An in vitro model to facilitate the study of endothelial cell seeding of damaged vascular surfaces has been developed. This may have applications in the study of endothelial seeding of angioplasty and endarterectomy sites. Using this model, the optimum endothelial seeding time for attachment to damaged vascular surfaces should not exceed 30 min and, to achieve confluent cell attachment, a seeding density &gt;5 × 105 cells/cm2 should be used.
Long-term results of treatment of peptic stricture of the oesophagus with the Angelchik prosthesis
Authors: Wyllie J H , Baker S R , Hakhamaneshi D , Soo K S , Edwards D A W 
Published: March 2007

Abstract
An Angelchik prosthesis was inserted in 43 patients with a peptic stricture above a hiatus hernia; 16 showed columnar lining of the oesophagus below the stricture. The mean preoperative bore of strictures was 8.7 mm. Within months, and without dilatation, 33 strictures shortened, 35 widened and of these 13 disappeared with a mean bore of 11.7 mm. In the long term, three more strictures resolved but three recurred. Final measurements gave a mean bore of 12.2 mm. The mean follow-up was 3.5 years. Symptomatic and radiological assessments suggested that the prosthesis was less effective when sited in the chest.
Sphincter rupture in childbirth
Authors: Sørensen M , Tetzschner T , Rasmussen O Ø , Bjarnesen J , Christiansen J 
Published: March 2007

Abstract
Thirty-eight women with rupture of the anal sphincter occurring during childbirth were followed for 3–12 months. Nineteen had complete rupture of the external and sphincter, 14 had a lesion involving more than half of the sphincter muscle and five had a superficial rupture. Fourteen patients presented with continence disturbances: nine to solid or liquid faeces and five to flatus. Incontinence was present in nine women 3 months after childbirth. Anal manometry and electromyography were performed in patients 3–5 days after delivery and repeated at 3,6 and 12 months. Manometry and electromyography were also performed in 16 control subjects who were nulliparous or had given birth more than 2 years previously and 24 primiparous controls, who were investigated at 3–5 days and at 3 months. There were significant differences between both incontinent and continent patients compared with nulliparous and primiparous controls. Primiparous control subjects had decreased anal squeeze pressure as well as decreased electromyographic activity on the first days after delivery compared with nulliparous controls. After 3 months no differences were found. Continence disturbances are frequent after sphincter rupture; these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.
Expression of p53 in colorectal cancer and dysplasia complicating ulcerative colitis
Authors: Taylor H W , Boyle M , Smith S C , Bustin S , Williams N S 
Published: March 2007

Abstract
An immunohistochemical method using Pab 1801, a monoclonal antibody specific to the human p53 protein, was applied to detect p53 expression in colorectal cancer and dysplasia complicating ulcerative colitis. Of 20 tissue samples with dysplasia, six showed positive immunoreactivity. Archival paraffin-embedded tissue blocks from 21 colitic cancers were analysed; 11 showed positive immunoreactivity, compared with ten of 21 samples from matched sporadic colorectal cancers (P not significant). Previous data suggesting that colorectal carcinoma complicating ulcerative colitis has a reduced frequency of c-Ki-ras mutation compared with sporadic cancer have led to the hypothesis that different genetic lesions underlie colitic and sporadic colorectal carcinoma. The present results suggest that this is not the case with regard to p53 gene alterations.
New technique to measure mucosal metabolism and its use to map substrate utilization in the healthy human large bowel
Authors: Chapman M A S , Grahn M F , Giamundo P , O'Connell P R , Onwu D , Hutton M , Maudsley J , Norton B , Rogers J , Williams N S 
Published: March 2007

Abstract
A new method of assessing substrate utilization in gastrointestinal mucosal specimens is described. Small human endoscopic biopsy specimens with wet weights ranging between 1.4 and 12.2 mg were used to quantify the oxidation of three metabolic substrates, glucose, glutamine and butyrate, through to carbon dioxide over a 2-h period. The technique proved to be reproducible and capable of distinguishing variations in mucosal metabolism between individuals (P &lt; 0.0001 for each substrate). Results were similar to those obtained previously using human and rat colonocytes. To characterize the metabolism of the healthy large bowel, specimens were obtained from five regions in 15 patients who had a normal colonoscopic examination. The results show that butyrate is the preferred fuel source of large bowel mucosa, followed by glutamine, then glucose (P &lt; 0.01). There was no significant regional variation in utilization of the three substrates between the five regions; with respect to glutamine, this is contrary to previous findings.
Abdominal aortic aneurysm: Still missing the message
Authors: Craig S R , Wilson R G , Walker A J , Murie J A 
Published: March 2007

Abstract
Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.
Role of reflux oesophagitis and acid in the development of columnar epithelium in the rat oesophagus
Authors: Seto Y , Kobori O 
Published: March 2007

Abstract
The role of reflux oesophagitis and acid in the development of oesophageal columnar epithelium was investigated in the rat. Twenty-four animals underwent total gastrectomy and oesophagojejunostomy, inducing reflux of duodenal contents into the oesophagus, and were divided into two groups: an ‘acid’ group, which drank syrup water with hydrochloric acid (pH 1.8), and a ‘non-acid’ group, which drank only syrup water (pH 6.5). Four rats were killed at 4, 8 and 12 weeks after surgery. Reflux oesophagitis was found in the lower portion of the oesophagus in all cases. Columnar epithelium was observed in the oesophagus of one rat in the non-acid group at week 8 and of three in the acid group at week 12. These results indicate that the development of columnar epithelium of the oesophagus is preceded by reflux oesophagitis and that acidic conditions may promote this change. Columnar epithelialization may result from metaplasia of squamous epithelium as well as from upward extension of columnar epithelium.
Norwegian multicentre study of survival and prognostic factors in patients undergoing curative resection for gastric carcinoma
Authors:   Members of The Norwegian Stomach Cancer Trial, Haugstvedt T K , Viste A , Eide G E , Söreide O 
Published: March 2007

Abstract
The influence of clinical and tumour-related variables on long-term survival in patients with gastric carcinoma was studied in a national prospective multicentre study. A total of 532 patients underwent curative surgery with a 5-year survival rate of 40 per cent. In a Cox multivariate analysis, age, stage of disease and macroscopic appearance of tumour were the only factors that independently affected survival. The estimated probability of survival to 5 years for a 50-year-old patient with a flattened tumour type and stage I disease was 71 per cent, but 50 per cent for an 80-year-old with the same tumour type and stage. For stage II disease the rates were 56 and 32 per cent, for stage III 39 and 13 per cent and for stage IV 19 and 3 per cent, respectively. A 70-year-old patient with stage II linitis plastica tumour type had an estimated probability of 5-year survival of 20 per cent. Stage of disease was the single most important factor in determining survival. Laurén histopathological type and location of tumour, Karnofsky performance index, weight loss and type of resection had no significant effect on long-term survival.
Obesity: An important prognostic factor in acute pancreatitis
Authors: Funnell I C , Bornman P C , Weakley S P , Terblanche J , Marks I N 
Published: March 2007

Abstract
Ninety-nine patients with acute pancreatitis in whom body mass index (BMI = weight (kg)/height2 (m2)) was measured were studied prospectively to determine the importance of obesity as a prognostic factor in this disease. Of 19 obese patients (BMI ⩾ 30 kg/m2), 12 developed severe pancreatitis; seven had abscesses, of whom five died, and two further patients died. In 80 non-obese patients, the incidence of severe pancreatitis (n = 5), abscess formation (n = 4) and death (n = 4) was significantly less (P = 0.0007). The mean(s.d.) BMI of 17 patients with severe acute pancreatitis was significantly higher than that in 82 patients with mild acute disease (31.2(5.6) versus 23.3(5.6) kg/m2, P &lt; 0.001). As a single prognostic factor, obesity had a sensitivity of 63 per cent and a specificity of 95 per cent for predicting disease severity. When five obese women with gallstone pancreatitis were excluded, the sensitivity of obesity increased to 86 per cent. Severe pancreatitis occurred in all eight obese patients with disease of an alcoholic aetiology. These data suggest that increased fat deposits in the peripancreatic and retroperitoneal spaces in obese patients may increase the risk of peripancreatic fat necrosis, abscess and death. Consideration should be given to including obesity as a prognostic factor in acute pancreatitis.