bluuebunny/crossref_metadata_2025_split huggingface dataset:
In situ femorodistal bypass: Novel technique for angioscope-assisted intraluminal side-branch occlusion and valvulotomy. A preliminary report
Authors: Stierli P , Aeberhard P 
Published: March 2007

Abstract
To allow and facilitate complete endoluminal vein preparation under angioscopic guidance for in situ femorodistal bypass grafting, a novel instrument was constructed. In experiments in cadavers we developed the occluder valvulotome, consisting of a modified Mills' valvulotome containing a laterally-ending working channel, a retrograde cutting blade and an advanceable Teflon® tube within the working channel. Using this instrument in combination with commercially available wire coils, we successfully performed five femorocrural in situ reconstructions with endoluminal valvulotomy and embolization of a total of ten thigh tributaries. The technique allows angioscope-assisted valvulotomy and simultaneous endoluminal tributary occlusion, making long skin incisions and extensive vein dissection obsolete.
Quantitative measure of small vessel anastomotic contour using corrosion resin cast models: An aid to surgical training
Authors: John L C H , Hornick P , Rees G M , Edmondson S J 
Published: March 2007

Abstract
A surgeon who had not previously carried out a small vessel anastomosis performed 20 consecutive anastomoses between human long saphenous vein and the left anterior descending artery of a pig's heart. Corrosion resin cast models were made of the anastomoses and subjected to a quantitative analysis of the anastomotic contour. A trend of improvement in contour parameters was found with increasing experience. This model may be useful for surgeons in training.
Effect of weight on claudication distance
Authors: Wyatt M G , Scott P M J , Scott D J A , Poskitt K , Baird R N , Horrocks M 
Published: March 2007

Abstract
Conservative measures to improve claudication distance include advice on smoking, exercise, diet and weight reduction. Although the effects of smoking, exercise and diet are established, the effect of weight is less clear. The aim of this study was to investigate the effect of carrying extra weight on the maximum walking distance in stable claudicants. Twenty stable claudicants were exercised on a treadmill (3.5 km/h, 0º slope) carrying 0, 2.5, 5, 7.5 and 10 kg weights in randomized sequence. Maximum claudication distance and ankle: brachial pressure indices were recorded. Patients were categorized into mild or severe claudicants depending on their ability to walk 200 m. A response index (RI) was calculated as the reduction in claudication distance per kilogram load; RI = [CD0 − CD10]/10 m/kg, where CD0 and CD10 represent claudication distance with 0 and 10 kg weights, respectively. Claudication distance was significantly reduced in subjects carrying 5 kg or more (P &lt; 0.01). A linear relationship was demonstrated between the mean claudication distance and the load carried (r = 0.98, P &lt; 0.01) with a mean response index of 10.2 m/kg. The mean(s.e.m.) RI in mild claudicants (25.9(9.5) m/kg) was greater than the value observed in the severe claudicants (3.3(0.8) m/kg; P &lt; 0.01, Mann-Whitney U test). This study demonstrates that weight adversely affects claudication distance and suggests that weight reduction may deserve greater emphasis in the management of some patients with intermittent claudication.
Role of splenectomy as a salvage procedure in thrombotic thrombocytopenic purpura
Authors: Wells A D , Young A E , Majumdar G , Slater N G P 
Published: March 2007

Abstract
Thrombotic thrombocytopenic purpura is a rare but serious haematological disease for which first-line therapy is medical, but not always successful. The role of splenectomy in the management of such patients is unclear. This paper reports three patients with the condition who went into remission following splenectomy after other forms of therapy had failed. Because thrombotic thrombocytopenic purpura is nearly always fatal if a remission is not obtained, splenectomy should be considered in patients who prove to be resistant to medical therapy.
Effects of different lipid emulsions on lymphocyte function during total parenteral nutrition
Authors: Sedman P C , Ramsden C W , Brennan T G , Somers S S , Guillou P J 
Published: March 2007

Abstract
A prospective randomized study of the immunological effects of three total parenteral nutrition (TPN) regimens in patients undergoing preoperative parenteral nutrition was conducted. In one regimen the calories were derived solely from glucose. The others were identical except that 50 per cent of the calories were provided as lipid emulsion, in one as long-chain triglycerides (LCT) only while the other contained half the fat as medium-chain triglycerides (MCT) and half as LCT (MCT/LCT). Natural killer (NK) activity and lymphokine-activated killer (LAK) activity were significantly higher after TPN with the MCT/LCT solution. A significant fall in LAK activity occurred after TPN with the LCT solution. The interleukin 2 content in supernatants from activated T lymphocytes was significantly higher after TPN with the LCT-containing solution. Solutions containing LCT and those containing MCT perturb cytokine interactions, but this is less with MCT-containing solutions, which may augment certain responses. These observations may have implications for the design of TPN regimens.
Relationship between blood transfusion and tumour behaviour
Authors: Francis D M A 
Published: March 2007

Abstract
Blood transfusion results in significant alterations in some parameters of immune function. Because some human cancers appear to stimulate immune responses and may be influenced by host immunity, the possibility arises that transfusion could alter the behaviour of tumours. Experimental studies indicate that allogeneic transfusion can directly alter tumour growth in some circumstances, but at present studies of human cancers do not provide evidence of a causal association between transfusion and tumour growth.
Sphincter injury after anal dilatation demonstrated by anal endosonography
Authors: Speakman C T M , Burnett S J D , Kamm M A , Bartram C I 
Published: March 2007

Abstract
Anal dilatation is still used in the treatment of anal fissure and haemorrhoids. Using anorectal physiology and anal endosonography we have studied 12 men presenting with faecal incontinence following anal dilatation. Resting anal pressures were low, pudendal nerve latencies were normal; 11 men had a disrupted internal anal sphincter and in ten this was extensively fragmented. Three also had defects of the external anal sphincter. These findings demonstrate for the first time the nature of the structural injury which may be caused by anal dilatation.
Lateral ligament division during rectopexy causes constipation but prevents recurrence: Results of a prospective randomized study
Authors: Speakman C T M , Madden M V , Nicholls R J , Kamm M A 
Published: March 2007

Abstract
Denervation of the rectum during rectopexy has been suggested as a reason for postoperative constipation. Bowel symptoms and anorectal function have been examined in a prospective randomized study of rectopexy with (n = 14) or without (n = 12) division of the lateral ligaments. Incontinence improved in both groups of patients. Division of the lateral ligaments increased the number of patients with constipation (three before operation, ten after operation, P&lt;0.01). Mean anal canal pressures were higher after operation in all patients. Rectal electrical sensory threshold increased significantly in those in whom the ligaments had been divided (preoperative 27.6 mA versus postoperative 56.7mA; P&lt;0.01) but not in those in whom they were preserved (39.0 versus 34.9 mA; P&gt;0.05). Prolapse recurred in six patients who did not undergo division of the lateral ligaments, but in none of the group in whom the ligaments were divided.
Prospective audit of an extramucosal technique for intestinal anastomosis
Authors: Carty N J , Keating J , Campbell J , Karanjia N , Heald R J 
Published: March 2007

Abstract
A computerized prospective audit was conducted of 500 intestinal anastomoses constructed in 470 operations on 461 consecutive patients between 1 January 1986 and 16 November 1990. All anastomoses were constructed by an open extramucosal method, emphasizing the avoidance of sutures through mucosa and avoiding the use of intestinal clamps. There were 214 men and 247 women, with a median age of 66 years. Clinical anastomotic leakage was detected from 11 (2.2 per cent) of 500 anastomoses. There were 18 (3.8 per cent) deaths resulting from the 470 operations, but only two (0.4 per cent) were associated with anastomotic leakage, which was not the direct cause of death in either. Peritonitis occurred as a consequence of leakage in two (8 per cent) of 26 resections for Crohn's disease, but the patients survived after reoperation. The single-layer extramucosal technique is probably the safest method available for intestinal suture.
Combined inguinal herniorrhaphy and transurethral prostatectomy
Authors: González-Ojeda A , de La Garza L , Marquina M , Calva J , Mendoza A 
Published: March 2007

Abstract
Between January 1979 and June 1988, 41 men underwent combined inguinal herniorrhaphy and transurethral prostatectomy at the Instituto Nacional de la Nutrición in México. These cases (group 1) were compared retrospectively with 100 consecutive cases of inguinal herniorrhaphy alone (group 2) and 100 consecutive cases of transurethral prostatectomy alone (group 3) during the same period. Group 1 had the highest incidence of preoperative risk factors because of age and associated medical problems. However, there were no significant differences in the rate of operative or postoperative complications between groups. No recurrences of inguinal hernia were recorded in group 1 after a follow-up period of 47.1 months. The length of hospitalization was similar between groups, and no patient died. Our observations suggest that when an inguinal hernia and symptomatic prostatism occur together, combined inguinal herniorrhaphy and transurethral prostatectomy is a practical, safe and effective operative procedure. The advantages of this combined procedure include one anaesthetic period, one operative procedure, one hospital stay and one convalescence with morbidity and mortality rates that are comparable to those of inguinal herniorrhaphy or transurethral prostatectomy alone.
Mechanical lithotripsy of large common bile duct stones using a basket
Authors: Chung S C S , Leong H T , Li A K C , Leung J W C 
Published: March 2007

Abstract
Experience with the Olympus basket mechanical lithotriptor (BML-1Q) in crushing large common bile duct stones before their endoscopic removal is reported. From January 1988 to January 1990, 68 patients with common duct stones too large to be extracted by Dormia baskets or balloon catheters after sphincterotomy were treated with the BML system. The largest stones in each patient ranged from 1.0 to 4.9 cm in diameter. Fifty-seven patients required one session of lithotripsy, ten patients two sessions and one patient three sessions; 26 patients required further endoscopic extraction of stone fragments after successful lithotripsy. The stones were successfully crushed by the BML system and the ducts cleared in 55 patients (81 per cent). In 13 patients mechanical lithotripsy failed because the stones could not be engaged in the lithotriptor basket. In one patient the stone was crushed with the Soehendra lithotriptor, six patients were successfully managed by electrohydraulic lithotripsy through a ‘mother and baby’ endoscope, indwelling stents were inserted in four patients and two patients underwent surgery.
Influence of epidural analgesia upon postoperative fatigue
Authors: Zeiderman M R , Clark R G , Welchew E A 
Published: March 2007

Abstract
This study examined the effect of epidural analgesia on the development of postoperative fatigue and the ability to ambulate after surgery. Seventeen patients admitted for elective abdominal surgery were randomized to receive postoperative analgesia with a continuous infusion of epidural fentanyl (epidural group) or intermittent intramuscular morphine (non-epidural group). Fatigue was assessed on an analogue scale of 1 (fit) to 10 (fatigued). Steady state measurements of respiratory gas exchange, respiratory rate, tidal volume and heart rate were made before operation and repeated on the third postoperative day. Energy expenditure was calculated from Weir's formula. Ambulatory measurements were made during treadmill walking at a work rate of 20 kpm min−1 (3.3 W). At rest, patients in both groups had a similar cardiorespiratory response to surgery irrespective of the method of analgesia. Subjective feelings of fatigue were significantly greater in those patients who had received epidural analgesia (P&lt;0.01) and patients in this group expended significantly more energy in performing the postoperative exercise test than did those in the non-epidural group (P&lt;0.05). The use of epidural opiate analgesia does not limit postoperative fatigue in patients undergoing upper abdominal surgery.
Role of salivary epidermal growth factor in the pathogenesis of Barrett's columnar lined oesophagus
Authors: Gray M R , Donnelly R J , Kingsnorth A N 
Published: March 2007

Abstract
Epidermal growth factor (EGF) is implicated in the regeneration of epithelial cells at the site of inflammation or ulceration in the gastrointestinal tract. Single parotid EGF concentration and production was studied in 64 patients with Barrett's columnar lined oesophagus (CLO), in 22 patients with severe reflux oesophagitis without columnar metaplasia and in 51 normal controls. In control patients, mean salivary EGF concentration was 2790 pg/ml (median 1450 pg/ml; range 450–16 500 pg/ml) and mean single parotid EGF production was 2550 pg/min (median 1750 pg/min; range 790–18000 pg/min). Patients with severe reflux oesophagitis had a similar EGF concentration (mean 3112 pg/ml; median 1500 pg/ml; range 300–16 000 pg/ml) and production (mean 3100 pg/min; median 2200 pg/min; range 790–17950 pg/min) to controls. Patients with CLO had a 62 per cent lower mean EGF concentration (mean 1197 pg/ml; median 640 pg/ml; range 233–4500 pg/ml) (P &lt; 0.001, Mann-Whitney U test) and a 60 per cent lower EGF production (mean 1254 pg/min; median 800 pg/min; range 170–3125 pg/min) (P &lt; 0.001, Mann-Whitney U test) than patients with severe reflux oesophagitis. A subpopulation with malignant change in CLO (n = 16) had a similar EGF concentration and production to the CLO group as a whole (mean 1240 and 1300 pg/min, respectively). Low salivary EGF levels are associated with Barrett's CLO but not with severe oesophagitis without columnar metaplasia. EGF levels do not identify those patients who will subsequently develop malignant change.
24-Hour survival of autotransfused red cells in elective aortic surgery: A comparison of two intra-operative autotransfusion systems
Authors: Kent P , Ashley S , Thorley P J , Shaw A , Parkin A , Kester R C 
Published: March 2007

Abstract
Twelve patients undergoing elective aortic surgery had intraoperative autotransfusion using either the Haemonetics Cell Saver or the Solcotrans device. The 24-h post-transfusion survival of the patients' preoperative red cells, labelled with indium-111, was compared with the survival of salvaged red cells labelled with chromium-51. A correction coefficient for the instability of the indium-111 label was calculated from the study of red cell survival in six healthy volunteers. There was no significant difference in the volume of circulating red cells measured using each isotope, indicating that extensive early destruction of the autotransfused red cells does not occur. The percentage survival of autotransfused red cells at 24 h was similar to that of the red cells that had not undergone salvage. Both devices were comparable with respect to the effects of cell salvage on the 24-h survival rate of autotransfused red cells.
Aggressive arterial reconstruction for critical lower limb ischaemia
Authors: Hickey N C , Thomson I A , Shearman C P , Simms M H 
Published: March 2007

Abstract
A consecutive series of 315 patients underwent arterial reconstruction for 329 critically ischaemic lower limbs over a 5-year period. Patients were not excluded from limb salvage surgery on the basis of poor run-off on preoperative angiography. Femorocrural bypass to a single calf vessel was required in 239 limbs (73 per cent); the 30-day cumulative mortality rate was 7 per cent, rising to 41 per cent at 5 years. Cumulative graft patency at 30 days, 1 year, 2 years and 5 years was 96, 85, 84 and 82 per cent respectively and was independent of the level of reconstruction. In situ long saphenous vein was the conduit of choice for distal bypass but, when this was absent, satisfactory results were obtained with arm vein or composite vein grafts. Acceptable results can be obtained for reconstructive surgery without preoperative angiographic selection of patients. An aggressive approach to limb salvage is therefore justified.
Risk factors for early lower limb loss after embolectomy for acute arterial occlusion: A population-based case-control study
Authors: Ljungman C , Adami H-O , Bergqvist D , Sparen P , Bergström R 
Published: March 2007

Abstract
To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8–11.2), chronic ischaemia (OR 2.1, CI 0.9–4.9), long duration of symptoms (OR 4.3, CI 1.9–9.6, for ⩾25 h versus ⩽6 h) or postoperative heart failure (OR 3.4, CI 1.8–6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1–0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1–0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.
Surgical palliation for pancreatic cancer: developments during the past two decades
Authors: Watanapa P , Williamson R C N 
Published: March 2007

Abstract
Improvements in pancreatic imaging over the past 20 years have revolutionized the preoperative diagnosis and assessment of resectability in patients with suspected pancreatic cancer. This review highlights the resultant trends in the surgical treatment of ductal carcinoma of the pancreas, comparing series reported between 1981 and 1990 with those from the previous decade. Small but worthwhile gains have been achieved both in overall resection rate and in the survival rate from such resections. Nevertheless, 80 per cent or more of afected patients are still unsuitable for resection because of the extent of their disease. Laparotomy retains a crucial role in the management of carcinoma of the pancreatic head, although percutaneous and endoscopic stents provide a useful alternative for palliation of malignant obstructive jaundice in elderly patients or those with carcinomatosis. Operation provides the chance to confirm the nature and full extent of the tumour, to circumvent duodenal obstruction and to abolish pain, besides relieving jaundice without the need for tubes (with their potential to block). By contrast, operative treatment generally has much less to offer in patients with carcinoma of the pancreatic body, unless diagnosis and irresectability remain in doubt. In combination, radiotherapy and 5-fluorouracil may achieve more as adjuncts to palliative surgery than either agent alone. The increasing safety of pancreaticoduodenectomy raises the possibility of palliative resection in younger patients with limited but incurable disease.
Therapeutic perihepatic packing in complex liver trauma
Authors: Krige J E J , Bornman P C , Terblanche J 
Published: March 2007

Abstract
Packing for control of haemorrhage was used in 22 of 294 patients undergoing surgery for liver trauma over a 6-year period. The major indication for packing was transfusion-induced coagulopathy. Sixteen patients had blunt trauma and six penetrating trauma including five gunshot wounds; 19 patients had major right lobe injuries, three left lobe and five also had hepatic vein injuries. Packing provided definitive control of bleeding in 18 patients but four patients had recurrent bleeding due to hepatic artery injury (three) and hepatic vein injury (one); three required further surgery and bleeding was controlled in the fourth by selective hepatic artery embolization. Six patients died and in two of these recurrent bleeding, despite packs, was a contributing factor. Mean blood loss in the six patients who died was 18 (range 10–30) units, compared with 13.1 (range 8–30) units in survivors. Packs were removed from the 16 survivors at laparotomy at a mean of 3.1 days after insertion; six patients rebled during pack extraction and were successfully repacked. Major morbidity occurred in 12 of the 16 survivors. Seven patients developed intra-abdominal sepsis following packing, one of whom died. Therapeutic liver packing provides life-saving control of hepatic bleeding which is frequently aggravated by coagulopathy. This approach permits resuscitation in an intensive care unit and subsequent planned relaparotomy for retrieval of packs and further intervention as necessary.
Effects of fine needle aspiration on subsequent mammograms
Authors: Horobin J M , Matthew B M , Preece P E , Thompson A J 
Published: March 2007

Abstract
The efects of fine needle aspiration on subsequent mammography were studied in a group of women who were referred with palpable breast lumps. Fifty-two women aged between 36 and 73 (median 53) years underwent mammography before and within 5 days of needle aspiration. Preaspiration and postaspiration mammograms were examined ‘blind’ by one radiologist. In ten cases, a diference was seen between the preaspiration and postaspiration films. In seven (aged 36–50 years) this was due to aspirated cysts. In three the diferences were unexpected and were more significant, although the radiological diagnosis was not altered. If this proportion is extrapolated for a large number of patients then significant numbers of artifacts from fine needle aspiration might be seen on mammograms. It is posssible that some might be interpreted falsely as malignant and some small cancers might be obscured. Women accepted mammography more readily before aspiration than after.
Progress in the management of head injury
Authors: Miller J D , Jones P A , Dearden N M , Tocher J L 
Published: March 2007

Abstract
Three 1-year surveys of head injury management spanning a 9-year period in a single regional centre are presented, There was a reduction in total numbers of head injury admissions after guidelines for admission and referral were implemented. More liberal use of computed tomography resulted in detection of a greater number of intracranial haematomas with the majority detected in non-comatose patients. The early mortality rate in severe head injury fell from 45 per cent to 34 per cent despite referral of large numbers of patients with multiple injuries and a substantial proportion (12per cent) of patients aged more than 70 years in whom outcome did not improve. Total occupied bednights and bednights occupied per surviving patient with severe head injury fell over the period of study. Care for patients with significant head injury should be based on regional neurosurgical units associated with trauma services.