bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic value of cytology for biliary stricture
Authors: Kurzawinski T , Deery A , Davidson B R 
Published: March 2007

Abstract
Over the past 20 years, bile aspiration at endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography has been developed for cytological diagnosis of biliary tract stricture. This safe and specific test has allowed a diagnosis to be reached before or without operation in about one-third of malignancies of the pancreas or bilary tree. The recent development of bilary brush cytology has produced better results. An endobiliary biopsy forceps is now available that may allow safe sampling of lesions causing extrinsic compression of the biliary tract. An endobiliary aspiration cytology needle has been produced that may permit non-ulcerating lesions to be diagnosed. A safe alternative to endobiliary methods is percutaneous fine-needle aspiration cytology; this yields a diagnosis in about half of patients presenting with obstructive jaundice and an imaged mass lesion.
Adrenal incidentaloma
Authors: Gajraj H , Young A E 
Published: March 2007

Abstract
Improvements in ultrasonogrpahy and computed tomography have led to the problem of ‘adrenal incidentaloma’, an asymptomatic adrenal mass discovered during investigation of some other problem. In the light of current knowledge a management rationale for patients with such an adrenal abnormality is proposed.
Perioperative blood transfusion and outcome after resection for colorectal carcinoma
Authors: Chung M , Steinmetz O K , Gordon P H 
Published: March 2007

Abstract
The degree of immunomodulation by perioperative blood transfusion and its effect on oncological surgery remain controversial. A major problem with previous clinical studies has been the inadequate patient population in each and the presence of confounding variables. To resolve some of the controversy, all studies published between 1982 and 1990 were reviewed using the statistical method of Mantel–Haentszel–Peto to determine a cumulative estimate of the direction and magnitude of this association. Some 20 papers were included in the analysis, representing 5236 patients. The cumulative odds ratios (95 per cent confidence interval) of disease recurrence, death from cancer and death from any cause were 1.80 (1.30–2.51), 1.76 (1.15–2.66) and 1.63 (1.12–2.38) respectively. These results support the hypothesis that perioperative blood transfusion is associated with an increased risk of recurrence of colorectal carcinoma and death from this malignancy.
Hyperaemic response in the skin microcirculation of patients with chronic venous insufficiency
Authors: Shami S K , Cheatle T R , Chittenden S J , Scurr J H , Coleridge Smith P D 
Published: March 2007

Abstract
The capacity of the microcirculation in the liposclerotic skin of patients with chronic venous insufficiency to vasodilate in response to pilocarpine electrophoresis was assessed using laser Doppler fluxmetry. Pilocarpine induces vasodilatation by direct action on capillaries; other methods of vasodilatation, such as heating of the skin, act by a number of pathways including a neurogenic one. Thirty patients with lipodermatosclerosis and chronic venous insufficiency and 20 control subjects were studied. There was no difference in peak vasodilatation following pilocarpine electrophoresis in the two groups. The median (interquartile range) peak flux in patients was 665 (382–1025) units and in controls 765 (452–975) units (95 per cent confidence interval of difference −270 to 150 units, P = 0.5). This suggests that the capillaries in the liposclerotic skin of patients with chronic venous insufficiency have a normal capacity to vasodilate.
Treatment of the axilla in patients with screen-detected breast cancer
Authors: Walls J , Boggis C R M , Wilson M , Asbury D L , Roberts J V , Bundred N J , Mansel R E 
Published: March 2007

Abstract
Management of the axillary lymph nodes in patients with screen-detected breast cancer is controversial. Optimal treatment should combine accurate determination of node status and avoidance of unnecessary morbidity. This study attempted to determine whether axillary node status could be accurately predicted using selected criteria in women with screen-detected breast cancer. Of 223 breast cancers excised in the Greater Manchester breast screening programme, 180 were invasive and 40 of these had associated lymph node metastases. The presence of involved nodes was associated with large tumour size, high tumour grade and the absence of mammographic microcalcification. Multiple logistic regression analysis revealed that each of these three factors was independently significant. Women with a screen-detected breast cancer &lt; 1 cm in diameter or those with grade I tumours &lt;3 cm (35 per cent of the total) could be spared axillary surgery with an expected reduction in morbidity and operating time.
Symptomatic outcome after laparoscopic cholecystectomy
Authors: Wilson R G , Macintyre I M C 
Published: March 2007

Abstract
To evaluate the symptomatic outcome after laparoscopic cholecystectomy, a standard symptom questionnaire was sent to three patient groups at least 1 year after surgery: 115 patients had undergone laparoscopic cholecystectomy; 200 had undergone open cholecystectomy; and 200 had had inguinal hernia repair. Return of questionnaires was higher after laparoscopic cholecystectomy (100 of 115; 87.0 per cent) than the open procedure (167 of 200; 83.5 per cent) or hernia repair (163 of 200; 81.5 per cent). There was no difference in the number of patients who considered the operation to have cured or improved their preoperative symptoms after laparoscopic cholecystectomy (94 of 100; 94.0 per cent), open cholecystectomy (157 of 167; 94.0 per cent) or hernia repair (154 of 163; 94.5 per cent). Similar numbers considered their operation to have been a success (94.0, 95.2 and 94.5 per cent respectively). The prevalence of abdominal pain, nausea, flatulence, food intolerance and heartburn was similar in all groups of patients following operation. Diarrhoea occurred more often following laparoscopic (6.0 per cent) and open (4.2 per cent) cholecystectomy than hernia repair (1.2 per cent). Patients who underwent laparoscopic cholecystectomy tended to have a higher incidence of nausea or vomiting than those undergoing the open procedure, and consumed significantly more antacids (23.0 versus 12.0 per cent, P &lt; 0.02). Laparoscopic cholecystectomy achieved the same rate of patient satisfaction as open cholecystectomy, with no apparent symptomatic advantage.
Reoperation for suspected primary hyperparathyroidism
Authors: Järhult J , Nordenström J , Perbeck L 
Published: March 2007

Abstract
A retrospective analysis of 93 patients undergoing 128 re-explorations for persistent or recurrent hypercalcaemia is presented. Seventy-six patients (82 per cent) became normocalcaemic after between one and five reoperations. Nine patients had hypercalcaemia caused by sarcoidosis, familial hypocalciuric hypercalaemia or metastatic disease, and two had parathyroid carcinoma. Fifteen patients (16 per cent) developed permanent hypoparathyroidism requiring vitamin D and/or calcium therapy and nine had permanent recurrent laryngeal nerve paralysis. Undetected adenomas (41 cases) and inadequate resection in hyperplastic disease (28) were the predominant causes of initial failure. Reoperation for persistent or recurrent hyperparathyroidism restored normocalcaemia in the majority of patients. This ‘cure’ was achieved at the cost of considerable morbidity and a careful risk-benefit analysis of each patient is recommended before performing reoperative parathyroid surgery.
Detection and significance of occult metastases in node-negative breast cancer
Authors: Hainsworth P J , Tjandra J J , Stillwell R G , Machet D , Henderson M A , Rennie G C , McKenzie I F C , Bennett R C 
Published: March 2007

Abstract
The clinical value of lymph node immunohistochemistry was assessed in 343 consecutive patients with apparently node-negative breast cancer using antimucin monoclonal antibodies BC2, BC3 and 3E1.2. Occult metastases were detected in 41 patients (12 per cent). Although most of these were micrometastatic (&lt; 2 mm in diameter), larger or diffuse deposits were found in ten patients. Blind assessment of repeat haematoxylin and eosin stained sections detected metastases in ten of the 41 patients with occult metastases. After a median follow-up of 79 months, patients with occult metastases had a shorter time to disease recurrence (P &lt; 0.05) but not to death. After adjustment for other prognostic factors, the presence of occult metastases in two or more nodes was the most significant predictor of both disease recurrence (P &lt; 0.01) and death (P &lt; 0.01). When the ten patients with positive haematoxylin and eosin sections were excluded from the analysis, the presence of occult metastases in two or more nodes was still associated with a reduced disease-free interval (P &lt; 0.05) and survival (P &lt; 0.05). Lymph node immunohistochemistry is a simple technique affording more accurate definition of nodal involvement than conventional methods.
Antibiotic prophylaxis is indicated for chest stab wounds requiring closed tube thoracostomy
Authors: Cant P J , Smyth S , Smart D O 
Published: March 2007

Abstract
To determine the role of antibiotic prophylaxis for stab wounds of the chest requiring intercostal tube drainage, a double-blind study was conducted comparing cefazolin, given to 57 patients at 500 mg every 8 h for 24 h, with placebo, given to 56. Differences were detected in the rate of thoracotomy for sepsis (antibiotic nil versus placebo 9 per cent, P &lt; 0.05) and in the frequency of sputa positive for pathogens (12 versus 34 per cent respectively, P &lt; 0.05), but the incidence of pyrexia, raised white cell count, positive cultures from pleural drainage or intercostal catheter tips and volume of chest drainage was similar. The mean hospital stay and costs consequent on morbidity were greater in patients receiving placebo, supporting the conclusion that antibiotic prophylaxis is indicated.
Vagal system involvement in changes in small bowel motility during restraint stress: An experimental study in the dog
Authors: Muelas M S , Ramirez P , Parrilla P , Ruiz J M , Perez J M , Candel M F , Aguilar J , Carrasco L 
Published: March 2007

Abstract
Changes in small intestinal motility were studied during restraint stress in fasting animals and after food; the involvement of the vagal system in the pathophysiology of these changes was assessed. Small intestinal motility was recorded in 40 dogs using electromyography with monopolar electrodes and manometry with submucosal microballoons. Twenty animals underwent bilateral truncal vagotomy. Stress increased intestinal motility (percentage of slow waves followed by action potentials in 1 min), both in fasting conditions (P &lt; 0.001) and postprandially (P &lt; 0.001). It also completely abolished the migrating motor complex–interdigestive myoelectric complex periodicity characteristic of the normal fasting pattern. In dogs subjected to vagotomy, restraint stress increased motility during fasting (P &lt; 0.001) but decreased it after feeding (P &lt; 0.01). Restraint stress thus increases small intestinal motility, both during fasting and after food. The vagal system is partially involved in this hypermotility response.
Graft size assessment by preoperative computed tomography in living related partial liver transplantation
Authors: Higashiyama H , Yamaguchi T , Mori K , Nakano Y , Yokoyama T , Yamamoto N , Yamaoka Y , Tanaka K , Kumada K , Ozawa K 
Published: March 2007

Abstract
The size of segmental liver grafts assessed by preoperative computed tomography (CT) volumetry was evaluated in relation to surgical outcome in 14 living related partial liver transplantations (LRLTs). The aim was to show that graft size can be accurately assessed before operation and to estimate the lower safety limit of graft size in assessing subsequent graft function and survival. The relationship between calculated CT volume and weight of the liver was linear in the recipient (r = 0.97) and donor (r = 0.98). The mean (s.e.m.) modified liver weight ratio (MLWR; ratio of graft weight to recipient's expected liver weight based on body-weight) was 0.59(0.07) (range 0.27–1.09). Surgical complications related to an oversized graft and primary graft failure caused by a small-for-size graft were not observed. The lowest MLWR of any survivor was 0.27. These results suggest that a partial liver graft reduced to about 30 per cent of the recipient's expected liver weight can tolerate LRLT well.
Treatment of perforated sigmoid diverticulitis: A prospective randomized trial
Authors: Kronborg O 
Published: March 2007

Abstract
A prospective randomized trial was carried out on 62 patients with diffuse peritonitis from perforated diverticulitis of the left colon, comparing acute transverse colostomy, suture and omental covering of a visible perforation with acute resection without primary anastomosis. For purulent peritonitis the postoperative mortality rate was significantly higher after acute resection (six of 25) than after colostomy (none of 21). In those treated by acute resection, the mortality rate was not significantly higher after Hartmann's procedure (five of 15) than after exteriorization of both lumens (one of ten). The postoperative mortality rate in patients with faecal peritonitis did not differ significantly between colostomy (six of ten) and acute resection (two of six). Stomas became permanent in four of 25 patients with diverticulitis surviving acute colostomy and in seven of 22 surviving acute resection. Suture and transverse colostomy is superior to resection for purulent peritonitis because of the lower postoperative mortality rate and in spite of the shorter hospital stay in those surviving acute resection.
Radiological investigation in acute diverticulitis
Authors: McKee R F , Deignan R W , Krukowski Z H 
Published: March 2007

Abstract
Optimal management of acute sigmoid diverticulitis depends on evaluation of the severity of the inflammatory process, in which radiological investigation is a useful but probably underutilized adjunct to clinical assessment. Plain abdominal radiography shows abnormalities in 30–50 per cent of patients but these tend to be non-specific and more accurate information is obtainable from a contrast enema. Although the quality of images produced by a water-soluble contrast agent is inferior to that with barium, the former is less hazardous in the presence of perforation and provides sufficient information to permit rational management decisions to be made. Ultrasonography and computed tomography (CT) are particularly useful in visualizing abscesses. They may be helpful in following the progression or resolution of suppuration and in guiding percutaneous aspiration when appropriate. Despite early reports to the contrary, CT is no more specific than a contrast enema in the diagnosis of acute diverticulitis. Radionuclide scans have little role in the routine assessment of acute diverticulitis and magnetic resonance imaging has not been adequately evaluated. Water-soluble contrast enema is safe, widely available and probably the most useful early supplementary investigation.
Tissue and urokinase plasminogen activators in the environs of venous and ischaemic leg ulcers
Authors: Stacey M C , Burnand K G , Mahmoud-Alexandroni M , Gaffney P J , Bhogal B S 
Published: March 2007

Abstract
Urokinase plasminogen activator (uPA) and tissue plasminogen activator (tPA) were assayed in biopsies from the base, edge and adjacent skin of ischaemic and venous ulcers using a functional bioimmunoassay and a standard immunoassay. Two series of 14 biopsies were examined: from seven venous and seven ischaemic ulcers in the first series, eight venous and six ischaemic in the second. It was found that tPA was detected in only four samples of ulcer edge using the bioimmunoassay and in no sample by the standard immunoassay. By contrast, uPA was detected in all but one ulcer edge biopsy and at a significantly lower median concentration in the adjacent skin (16.9 units/g) than the ulcer edge (26.1 units/g) or base (32.3 units/g) (both P &lt; 0.01). Levels of uPA were greater in the edge and base of venous compared with ischaemic ulcers. The predominant plasminogen activator in chronic leg ulcers is uPA; this activator may play an important role in wound healing.
Prognostic significance of cell culture in carcinoma of the oesophagus
Authors: Shimada Y , Imamura M 
Published: March 2007

Abstract
The prognostic significance of the potential of cells to grow in tissue culture was studied in 50 patients with oesophageal cancer. The ability of cell lines to grow from resected oesophageal specimens was determined; from 50 patients, 21 cell lines were established (42 per cent). The patients were divided into two groups on this basis: group 1, from whom cancer cells could be grown as continuous cell lines and group 2, from whom cell lines could not be established. The cumulative survival rate of patients in group 1 was significantly lower than that of those in group 2 (P &lt; 0.05). There was also a significantly higher incidence of lymph node metastases in group 1 (P &lt; 0.05). These results suggest that the potential of cancer cells for growth is a useful long-term prognostic indicator for patients with oesophageal carcinoma.
Prospective randomized study of one- or two-layer anastomosis following oesophageal resection and cervical oesophagogastrostomy
Authors: Zieren H U , Müller M , Pichlmaier H 
Published: March 2007

Abstract
In a prospective randomized study, one- and two-layer anastomoses were compared following subtotal oesophagectomy and gastric substitution with cervical oesophagogastric anastomosis. After 54 one- and 53 two-layer procedures the rates of anastomotic leakage were the same (19 per cent). After a mean follow-up of 44 weeks, 13 of 51 patients (25 per cent) undergoing one-layer anastomosis and 28 of 50 (56 per cent) having the two-layer procedure complained of cervical dysphagia and required dilatation. The anastomotic strictures were fibrotic in 11 of 51 patients (22 per cent) undergoing one-layer anastomosis and in 24 of 50 (48 per cent) receiving the two-layer operation. Strictures were malignant in two and four patients (4 and 8 per cent) respectively. The lower incidence of fibrotic stricture following one-layer anastomosis was significant (P &lt; 0.01), but not that of malignant stricture. With comparable leakage rates, one-layer anastomosis is superior to the two-layer procedure because of the lower incidence of fibrotic stricture.
Incidence of haemorrhoids and anorectal varices in children with portal hypertension
Authors: Heaton N D , Davenport M , Howard E R 
Published: March 2007

Abstract
A prospective study of 60 children with portal hypertension showed a significant incidence of haemorrhoids (33 per cent), anorectal varices (35 per cent) and external anal varices (15 per cent). Four children (7 per cent) complained of anorectal symptoms. A comparison of extrahepatic with intrahepatic disease showed that the former was associated with a higher incidence of both haemorrhoids and anorectal varices (57 versus 26 per cent and 64 versus 26 per cent respectively). The occurrence and severity of haemorrhoids was related to the number of previous oesophageal sclerotherapy sessions (P = 0.001). Problems relating to anorectal pathology were unusual, but treatment with haemorrhoidal sclerotherapy or banding was satisfactory for the symptomatic patients.
Cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation
Authors: Tanaka K , Nishimura A , Yamada K , Ishibe R , Ishizaki N , Yoshimine M , Hamada N , Taira A 
Published: March 2007

Abstract
The aim of this study was to delineate clinical features and prognosis of cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation, and to determine methods for managing the disease. A retrospective study of seven patients is presented. A further 27 cases from the Japanese literature were reviewed retrospectively with regard to method of treatment and prognosis. In 11 of 18 patients in whom staging was known the tumour was stage V, representing advanced disease. In seven of 34 cases curative operation was performed; only two patients survived for &lt; 3 years. This poor outcome was due largely to delayed diagnosis of cancer of the gallbladder. Prophylactic cholecystectomy is recommended in patients with this anomalous junction without bile duct dilatation or a malignant lesion in the gallbladder, because of the high incidence of cancer of the biliary tract.
Vibration white finger
Authors: Palmer R A , Collin J 
Published: March 2007

Abstract
Vibration white finger (VWF) occurs in workers who use vibrating tools. On exposure to vibration or cold, patients experience blanching, numbness and pain in the fingers due to exaggerated vasoconstriction. This may involve both central sympathetic hyper-reactivity and local vasoactive factors. In advanced cases, hypertrophy of vascular smooth muscle causes arterial occlusion and ulceration. Diagnostic tests for VWF are unreliable. In early cases, cessation of vibration exposure arrests the progression of disease and may cause symptom remission. Patients with VWF should keep themselves warm, especially their hands, which they should place in warm water at intervals during the day; they should not smoke. Vasoactive drugs may be beneficial in some patients. In the UK, Industrial Injuries Disablement Benefit and compensation are sometimes available. Improved design of tools and restrictions on their operating time have been the main factors leading to a worldwide decline in the incidence of VWF since the early 1970s.
Safe margins in the excision of primary cutaneous melanoma
Authors: Neades G T , Orr D J A , Hughes L E , Horgan K 
Published: March 2007

Abstract
A group of 434 patients treated for primary cutaneous melanoma over an 18-year period by a policy of selective excision margins based on clinical estimation of tumour thickness was studied prospectively. Clinical assessments of tumour as impalpable, palpable but not overtly nodular, and nodular correspond to thicknesses of ⩽ 0·75, 0·76-1·49 and ⩽ F 1.50 mm respectively. From 1971 to 1987, 330 patients were treated with excision margins of 1, 2 and 3-5 cm based on these respective ranges. During 1988 and 1989, 104 patients were treated after reduction of the maximum width of excision to 2 cm. The overall local recurrence rate was 11 of 434 patients (2·5 per cent), with no recurrence in melanoma ⩽ 0·75 mm thick and no increase in the local recurrence rate after reduction of the maximum margin from 3 to 2 cm. A policy of 2-cm clearance for palpable and nodular melanoma and I cm for impalpable lesions is recommended. Any further reduction must be tested prospectively.