bluuebunny/crossref_metadata_2025_split huggingface dataset:
Warfarin inhibition of metastasis: The role of anticoagulation
Authors: McCulloch P , George W D 
Published: March 2007

Abstract
Warfarin inhibits metastasis in animal models by mechanisms that remain unclear. A better understanding of this phenomenon may clarify processes underlying metastasis in human cancer. We have studied the effects of warfarin on metastasis in a rat model by intravenous injection of Mtln3 mammary carcinoma cells and subsequent counting of pulmonary seedlings. To determine whether warfarin acts principally on the tumour cell or the host, we pretreated either cells or animals with warfarin before intravenous injection of 104 Mtln3 cells. Pretreatment of tumour cells had no effect, whilst pretreatment of the host reduced median seedlings from 67 to 4·5 per animal (P &lt; 0·005). To determine whether warfarin was acting via its anticoagulant action, we reversed warfarin anticoagulation by intravenous injection of coagulation factors II, VII, IX and X. Restoration of coagulation for 12 h immediately after injection of cells completely reversed the warfarin effect (P &lt; 0·001), but if the injection of factors was delayed for 12 h it had no effect (P = 0·1753). We conclude that warfarin acts principally on the host, not the tumour cell, and that it acts via its effect on coagulation. The restriction of the effect to the first 12h after tumour cell injection suggests a mechanism involving intravascular processes such as tumour cell survival or endothelial adhesion.
Gastric emptying and clinical outcome after Roux-en-Y diversion
Authors: Britton J P , Johnston D , Ward D C , Axon A T R , Barker M C J 
Published: March 2007

Abstract
The results of 48 Roux-en-Y (RY) diversion procedures are reported: 41 were performed as secondary procedures and 7 as part of a primary operation for peptic ulcer. There was no operative mortality, but four patients developed temporary fistulae in the postoperative period and three patients required reoperation. Good clinical results were found when RY diversion was performed as a primary procedure or when the indication for operation was peptic ulceration. The overall results, however, were poor: 24 patients (50 per cent) felt that they had not benefited and 32 patients (67 per cent) remained in Visick grades 111 or IV. The main cause of failure was gastric stasis, especially of solid food. Gastric emptying studies were carried out after RY diversion in 22 patients, most of whom had symptoms of stasis. Emptying of liquids was found to be normal in most patients, but emptying of solids was delayed, the median t1/2 for solids being 160 (75–370) min compared with 67 (50–85) min in DU patients. Bilious vomiting improved significantly after RY diversion, but 18 patients (38 per cent) complained of vomiting food and 32 patients (67 per cent) experienced postprandial distress or pain. Loss of the antral mill, vagotomy of the gastric remnant and, perhaps, resistance to gastric emptying by the Roux loop itself may together explain the delay in gastric emptying of solids after RY diversion.
Multicentre clinical trial of low volume fresh frozen plasma therapy in acute pancreatitis
Authors: Leese T , Holliday M , Heath D , Hall A W , Bell P R F 
Published: March 2007

Abstract
Fresh frozen plasma (FFP) has been proposed as a specific therapy for acute pancreatitis. Reduced mortality encountered in an uncontrolled clinical study and a controlled experimental study may be attributable to replenishment by FFP of the naturally occurring antiprotease system. To investigate this potential therapy further, 202 patients presenting with acute pancreatitis were randomized to receive FFP (2 units daily for 3 days) or a similar volume of colloid control as part of their intravenous fluid therapy. Clinical progress was monitored and the major serum antiproteases (α1-antiprotease and α2-macroglobulin) were measured on days 1, 3 and 7. There was no significant difference between the two groups in terms of clinical outcome. α1-Antiprotease levels rose significantly from day 1 to day 3 in both groups (P &lt; 0·0001) and remained elevated at day 7. α1-Antiprotease is an acute phase protein in man and raised serum levels would be anticipated. FFP appears to have no effect on the magnitude of this rise. Serum α2-macroglobulin levels were reduced in both groups on day 1 and continued to fall significantly from day 1 to day 3 in the colloid control group (P &lt; 0·005) whilst remaining substantially unaltered in patients receiving FFP (P = 0·6527). α2-Macroglobulin plays a central role in the elimination of proteases during acute pancreatitis and the ability of relatively low volumes of FFP to reduce the fall in serum α2-macroglobulin levels seen during the early stages of this disease may have therapeutic implications.
Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients
Authors: Neoptolemos J P , Davidson B R , Shaw D E , Lloyd D , Carr-Locke D L , Fossard D P 
Published: March 2007

Abstract
The outcome of 438 consecutive patients who had exploration of the common bile duct and/or endoscopic sphincterotomy (ES) in a 5-year period was reviewed. Patients were analysed according to four groups: 59 patients had planned ES followed by surgery resulting in 14 major complications (23·7 per cent) including 3 deaths (5·1 per cent) (group 1); 248 patients had surgery alone with 21 major complications (8·5 per cent) including 10 deaths (4·0 per cent) (group 2); 114 patients with gallbladder in situ underwent ES alone with 22 major complications (19·3 per cent) including 9 deaths (7·9 per cent) (group 3); 17 patients with remote cholecystectomy also had ES alone with 3 major complications (17·6 per cent) including 3 deaths (17·6 per cent) (group 4). There was no difference in mortality between the groups. Compared with group 2, major complications were significantly higher in group 1 (χ2 = 11·0, d.f. = 1, P &lt; 0·001) and in group 3 (χ2 = 8·6, d.f. = 1, P &lt; 0·003). Patients in group 3, however, were significantly older than those in groups 1 and 2, and the former also had higher medical and total risk factor scores than the latter (all P &lt; 0·001). The results indicate that routine pre-operative ES is of que: ionable value. ES alone is justified in elderly high risk patients; mortality in this group might be reduced by improved management of post-ES complications.
Small bowel obstruction: Computer-assisted prediction of strangulation at presentation
Authors: Pain J A , Collier D St J , Hanka R 
Published: March 2007

Abstract
A multivariate computer analysis has been performed on the presenting data of patients with simple small bowel obstruction that settled with conservative treatment (n = 120) and of patients with viable strangulation small bowel obstruction (n = 38) and non-viable strangulation small bowel obstruction (n = 39) found at operation. Initially only 66 per cent of patients with viable strangulation and 46 per cent of those with non-viable strangulation had been treated by immediate surgery after resuscitation. The remainder had been treated conservatively for a median of 3·8 and 2·2 days respectively before undergoing surgery. The computer predicted on the basis of presenting symptoms and signs that 82 per cent of patients with viable strangulation and 97 per cent of those with non-viable strangulation had or would develop strangulation and should have undergone immediate surgery. We advocate that the computer can assist in the management of patients with small bowel obstruction.
Long-term effect of carotid endarterectomy on carotid sinus baroreceptor function and blood pressure control
Authors: Dehn T C B , Angell-James J E 
Published: March 2007

Abstract
In order to assess whether carotid endarterectomy had any long-term hypotensive effect, by altering the function of the carotid sinus baroreceptors, blood pressure and carotid sinus baroreceptor function were recorded in 25 patients undergoing carotid endarterectomy. No overall change in blood pressure was recorded 6 months after surgery. Sinus function was shown to decrease in 2 (8 per cent), to remain unchanged in 15 (60 per cent) and to increase in 8 (32 per cent) patients 6 months postoperatively. There was no relationship between changes in sinus function and changes in blood pressure over the 6 months period. Thus, carotid endarterectomy has no long-term hypotensive effect.
Reduction of the surgical excision rate in benign breast disease using fine needle aspiration cytology with immediate reporting
Authors: Dixon J M , Clarke P Jane , Crucioli V , Dehn T C B , Lee E C G , Greenall M J 
Published: March 2007

Abstract
Patients attending a breast clinic in two different periods were studied. In the first period fine needle aspiration cytology (FNAC) was not available and in the second it was used on all discrete solid breast lumps and reported immediately in the clinic. With the use of FNAC the overall surgical excision rate for discrete solid lumps was reduced from 83 percent to 41 percent and the excision rate in patients with benign disease was reduced from 74 per cent to 23 per cent (P&lt;0·001). All patients with breast cancer in the second period had malignant cytology and no patient with benign or acellular cytology has been shown, after a minimum follow-up period of 18 months, to have breast cancer. Using FNAC with immediate reporting, the number of operations performed in patients with benign breast disease can be safely reduced.
Insulin resistance in patients with colorectal cancer
Authors: Copeland G P , Leinster S J , Davis J C , Hipkin L J 
Published: March 2007

Abstract
The euglycaemic glucose clamp technique has been used to assess insulin resistance in patients with colorectal adenocarcinoma. Ten cancer patients were studied and compared with control subjects matched for age, sex and nutritional status. Forty-one euglycaemic clamps were performed at one of five different insulin infusion rates (20, 30, 40, 100 or 200 milliunits min−1 m−2). Glucose disposal was significantly decreased in the cancer group at all insulin infusion rates, whilst attained insulin levels and metabolic clearance rates of insulin were comparable in the control and cancer groups. Analysis of dose-response data allowed assessment of sensitivity (insulin concentration of half maximal glucose disposal) and responsiveness (maximal glucose disposal). Responsiveness was significantly reduced in the cancer group (40·3 versus 71·5 μmol kg−1 min−1; P&lt;0·001), whilst sensitivity was similar (93·7 milliunits l−1 in controls versus 90·8 milliunits l−1 in cancer patients), suggesting a postreceptor defect in insulin action in the cancer group.
Exfoliated cells and in vitro growth in colorectal cancer
Authors: Skipper D , Cooper A J , Marston Jane E , Taylor I 
Published: March 2007

Abstract
Cells exfoliated from colorectal cancers may only be implicated in local recurrence if they are proven to be viable and capable of growth. Thirty patients with primary colorectal cancer were studied. Cells were obtained from primary tumour, uninvolved mucosa, mesorectum, lumen of the bowel, luminal mucus, serosal surface of the bowel and from washings of the tumour bed after dissection. Colonies grew in vitro in monolayer culture from 21/30 primary tumours; 11/41 mesorectum specimens; 11/27 luminal washings; 14/29 luminal mucus specimens; 1/27 serosal surface washings and 3/13 post-dissection washes. Colonies stained positively for the epithelial markers cytokeratin and desmosomes and also for carcinoembryonic antigen. Cells capable of in vitro growth are present in these various sites and, if spilled at operation, may well be implicated as one of the factors leading to local recurrence.
Non-invasive endoscopic technique to assess gastrointestinal perfusion
Authors: Allen P I M , Gourevitch D , Goldman M 
Published: March 2007

Abstract
Changes in mucosal blood flow may occur in many gastrointestinal disorders, but assessment is impossible without a non-invasive in vivo technique. We have compared endoscopic laser Doppler (LD) with oxygen electrode (OE) measurements in a dog isolated colon preparation, using variable perfusion measured with an electromagnetic flow probe. At maximum flow, LD measurements were made at three sites to compare mucosal with serosal readings. Flow rate was varied (1-38 ml/min) and measurements of microcirculatory flux obtained using LD, and of oxygen tension using a serosal OE. A progressive trend towards increasing flux was demonstrated from caecum to rectum—serosa: 46·8 ± 18·7 V (caecum), 52·6 ± 17·9 V (mid-colon) and 61·3 ± 17·6 V (rectum). A parallel trend was observed in mucosal values: 41·1 ± 18·2 V (caecum), 45·7 ± 15·2 V (mid-colon) and 54·1 ± 15·1 V (rectum). At all sites, serosal and mucosal values were not significantly different (Student's t test). LD serosal values correlated significantly with EM flow (r = 0·544, 0·01 &gt; P &gt; 0·001). A similar linear correlation was found between OE and EM flow (r = 0·65, P&lt;0·001). Oxygen tension measurements varied as expected with microcirculatory flux (r = 0·441, 0·02 &gt; P &gt; 0·01). Endoscopic LD assessment of colonic microcirculation accurately reflects changes in blood flow.
Prospective 14- to 18-year follow-up study after parietal cell vagotomy
Authors: Hoffmann J , Olesen A , Jensen H-E 
Published: March 2007

Abstract
One hundred and thirty-five patients underwent elective parietal cell vagotomy- for duodenal, pyloric or prepyloric ulcers. The patients were followed prospectively at intervals of 1-3 years in order to detect postvagotomy symptoms and recurrent ulcers; 14-18 years after surgery 106 patients were studied with regard to recurrent ulceration and 84 concerning postvagotomy symptoms. Thirty-two patients (30 per cent) had developed proven recurrent ulcers and a further 9 per cent were suspected of having recurrences. Two patients were reoperated for gastric outlet obstruction and one for bile reflux gastritis. Four patients had severe dyspeptic symptoms and four severe dyspepsia plus dumping. No patient had severe diarrhoea. Forty-three patients were regarded as failures after parietal cell vagotomy. After treatment of these failures 88 per cent of the patients available for subsequent follow-up had satisfactory results. The alternatives to parietal cell vagotomy are discussed. It is concluded that although parietal cell vagotomy has a high long-term recurrence rate, this disadvantage is outweighed by the low incidence severe postvagotomy symptoms.
Effects of fundoplication on the antireflux mechanism
Authors: Johnsson F , Joelsson B , Gudmundsson K , Florén C-H , Walther B 
Published: March 2007

Abstract
Forty patients with a diagnosis of gastro-oesophageal reflux disease established by 24-h ambulatory pH monitoring were treated by a short 360° fundoplication. Results of postoperative evaluation at 6 months were compared with those from 50 normal volunteers. The amount of gastro-oesophageal reflux at pH monitoring decreased significantly and was less than the reflux in the normal subjects. The pressure and the intra-abdominal length of the distal oesophageal high-pressure zone increased significantly. The pressure was similar to that in the normal subjects while a significantly longer intra-abdominal part of the high-pressure zone was created. The clinical results of the operation were evaluated in 38 patients by an independent gastro-enterologist, and were considered to be excellent in 22 patients, good in 13, fair in 2 and poor in 1 patient. The antireflux procedure provided good control of the gastro-oesophageal reflux in our patients by restoring the major components of the antireflux mechanism.
Factor X-activating activity in patients with colorectal carcinoma
Authors: Dover R , Goeting Nicola L M , Taylor I , Roath O S , Francis J L 
Published: March 2007

Abstract
The ability of malignant tissue from 50 patients with colorectal carcinoma to activate blood coagulation factor X directly was compared with samples of adjacent, macroscopically normal colonic mucosa from the same patients, and tissue from four patients with non-malignant bowel disease. The resected tissue was homogenized and incubated with purified factor X and calcium ions. The subsequent generation of activated factor X was measured spectrophotometrically with a chromogenic substrate. Results were expressed as absorbance units, and as the ratio of tumour and normal activities. Factor X-activating activity (FXAA) was present in all normal and malignant tissues tested. FXAA was significantly greater (P&lt;0·001) in the tumour homogenates than in the uninvolved tissue. The tumour:normal ratio was significantly (&gt; 1·2) elevated in 38 patients (76 percent). FXAA was not correlated with the degree of differentiation of the tumour, the Dukes' classification of the disease or the exact site of the tumour. There was no difference between the FXAA content of non-involved tissue from the colorectal cancer group and colonic mucosa from patients with non-malignant bowel disease. It is concluded that colorectal carcinomas contain significantly more FXAA than adjacent, non-malignant colonic mucosa from the same subject, but there is no direct evidence for a relationship between procoagulant levels and the extent of malignancy in these patients.
Randomized trial comparing anorectal myectomy and controlled anal dilatation for outlet obstruction
Authors: Yoshioka K , Keighley M R B 
Published: March 2007

Abstract
A randomized controlled study has compared anorectal myectomy (n=13) with anal dilatation (n=10) using Park's anal retractor for patients with constipation. No patient was able to defaecate spontaneously more than three times a week before the operation. Of the 13 patients, 7 were able to defaecate spontaneously more than three times a week after anorectal myectomy, compared with none after anal dilatation (P&lt;0·05). None of the patients in either group became incontinent. There was a significant fall of anal canal pressure after anorectal myectomy at rest, during maximum pelvic floor contraction, and attempted defaecation: median, 100 (range, 21-200) to 43 (20-133) cmH2O, P&lt;0·01; 140 (79-238) to 86 (43-153) cmH2O, P&lt;0·01; 127 (79-208) to 86 (29-167) cmH2O, P&lt;0·005. A significant improvement in rectal emptying occurred after anorectal myectomy (median, 0 percent/min (range, 0-83) to 50 (0-100) per cent/min, P&lt;0·025). On the other hand, anal dilatation was not associated with any significant change in rectal emptying or anal pressure. Pre-operative anal pressures during attempted defaecation in patients who achieved a good result after anorectal myectomy were significantly higher than those that did not (median, 136 (range, 120-208) versus 114 (79-129) cmH2O, P&lt;0·025). Patients having a good result after anorectal myectomy had a significantly shorter history of constipation (median, 4 (range, 2-14) versus 38 (4-72) years, P&lt;0·01) and normal colonic transit (median, 100 (range, 4-100) versus 10 (0-90) years, P&lt;0·05) compared with those who had no benefit after operation.
Growth rate of human tumour xenografts measured in nude mice by in vivo cast modelling
Authors: Fiennes A G T W 
Published: March 2007

Abstract
Caliper measurement of xenograft tumour volume incurs shape-dependent errors of up to 230 per cent. A more sensitive and accurate method is described for repeated in vivo measurement of tumour volume by cast modelling. The technique can provide electronic data for further analysis and its accuracy and limitations can themselves be determined. Week-on-week changes in tumour volume may be detected with up to 99 per cent confidence.
Prognostic significance of DNA ploidy in colorectal cancer: A prospective flow cytometric study
Authors: Jones D J , Schofield P F , Moore M 
Published: March 2007

Abstract
A prospective study of prognostic factors has been carried out in a group of 123 consecutive patients with colorectal cancer. The fate of all patients is known at 3 years after operation. Clinical and pathological data were recorded at the time of presentation and operation, and the patients have been subject to regular postoperative review. DNA ploidy status was determined by flow cytometry. In all, 39 (33 per cent) patients had DNA diploid tumours and 80 (67 per cent) patients had DNA aneuploid tumours. In four cases, tumour material was not obtained. The patients with DNA aneuploid tumours had a worse prognosis than those with DNA diploid tumours, but this was only seen in those patients classified as Dukes' B. In a Cox's regression analysis, the surgeon's assessment of operability was the strongest predictor of survival, followed by the pathological classification and the patient's age. After these factors had been considered, the DNA ploidy status conferred no independent survival value.
Prospective study of the effects of postanal repair in neurogenic faecal incontinence
Authors: Womack N R , Williams N S , Morrison J F B 
Published: March 2007

Abstract
The most important factor associated with a good result in the surgical treatment of neurogenic faecal incontinence by postanal repair is considered to be restoration of the obtuse anorectal angle. Sixteen patients (14 F:2 M; median age 59 years) with neurogenic faecal incontinence confirmed by a raised fibre density in the external anal sphincter underwent postanal repair. Pre- and postoperative manometric assessment was performed in 16 and radiological assessment in 12. Normal ranges for these parameters were established in age and sex matched control subjects. Continence was improved in 14 (88 per cent) patients, 6 (38 per cent) of whom regained normal continence, at a minimum of 15 months follow-up. A successful outcome was associated with no significant change in basal (pre-operative 35 (10–85) cmH2O, postoperative 44 (12–105) cmH2O; n.s.) or voluntary (pre-operative 43 (5–150) cmH2O, postoperative 32 (12–180) cmH2O; n.s.) components of anal canal pressure. There was a small but significant increase in sphincter length (pre-operative 2 (0–3) cm, postoperative 2·5 (0–3·5) cm; P &lt; 0·01). There was no significant change in the anorectal angle at rest (pre-operative 96 (90–110) degrees, postoperative 107 (79–118) degrees; n.s.) in the patients in whom continence was restored and five of these patients had resting anorectal angles within the normal range (75–94 degrees). Thus postanal repair need not be restricted to patients with widening of the anorectal angle since its beneficial effects do not appear to be related to reduction of this angle.
Maximal isokinetic muscle strength in patients with primary hyperparathyroidism before and after parathyroid surgery
Authors: Joborn Charlotte , Joborn H , Rastad J , Äkerström G , Ljunghall S 
Published: March 2007

Abstract
Primary hyperparathyroidism (HPT) is associated with symptoms of generalized fatigue and muscle weakness. The purpose of this study was to investigate muscular function in HPT quantitatively and to evaluate the effect of parathyroid surgery in this respect. The maximal isokinetic muscle strength (peak torque) of knee extension and flexion was measured with a Cybex-II dynamometer in 16 patients with primary HPT (mean serum calcium 2·81 ± 0·14 mmol/l), four of whom had subjective impairment of strength, and in nine control patients submitted to hemithyroidectomy due to atoxic thyroid adenoma. Before surgery there was no significant difference in muscle strength between the two groups, neither was there any consistent relationship between the subjective feeling of muscular weakness and the measured peak torque. Seven months after surgery the HPT patients had increased their muscle strength by 8 per cent (P&lt;0·05). The improvement was correlated with the pre-operative serum calcium levels (r = 0·56, P = 0·02) and was particularly seen in patients with pre-operative subjective muscular weakness. Patients with only slightly raised calcium values and without subjective muscular symptoms did not benefit clearly from surgery, compared with the controls. The study demonstrates that HPT patients, especially those with neuromuscular symptoms, can improve their muscle strength after parathyroid surgery.