bluuebunny/crossref_metadata_2025_split huggingface dataset:
Additional value of fine-needle aspiration biopsy in a mammographic screening trial
Authors: Frisell J , Eklund G , Nilsson R , Hellström L , Somell A 
Published: March 2007

Abstract
The Stockholm breast cancer screening trial used single-view mammography as the sole screening method. A majority (63 per cent) of the mammographic selected cases from the first two screening rounds had uncertain mammograms, coded as 3 on an ordinal scale from 1 to 5, where 1 and 2 are dismissed as normal mammograms and 5 stands for a typical cancer. In this group of uncertain mammograms 30 cases were malignant and 431 were non-malignant. The aim of this study was to examine whether surgical biopsy in this group could be replaced by fine-needle aspiration (FNA) biopsy, combined with the information from the mammogram and clinical examination, and whether this diagnostic' strategy could select the malignant cases with a high sensitivity. FNA biopsy selected 25 of the 30 mammary carcinomas as definite malignancy or atypia, with a sensitivity of 83 per cent (95 per cent confidence interval: 69–96 per cent), and combined with the information from the mammogram and clinical examination 29 of the malignancies were selected with a sensitivity of 97 per cent (95 per cent confidence interval: 83–100 per cent). In 398 of 431 non-malignant cases the diagnosis was established with the triple diagnostic approach without needing a surgical biopsy. In a clinical follow-up study, up to 64 months after the first screening round, only one false negative case was found, included in the group of 30 malignancies described above. With this strategy the rate of negative surgical biopsies was reduced by 90 per cent in the group with uncertain mammograms and without considerably impairing the reliability of the results.
Anastomotic aneurysms of the femoral artery: Aetiology and treatment
Authors: Clarke A M , Poskitt K R , Baird R N , Horrocks M 
Published: March 2007

Abstract
The aetiology and treatment of 35 femoral false anastomotic aneurysms in 29 patients presenting over the 4-year period 1984–88 were reviewed retrospectively. The mean interval between primary anastomosis and false aneurysm repair was 6 years (range from 2 weeks to 16 years). Twenty-two (63 per cent) false aneurysms had occurred after previous aortobifemoral bypass grafting for occlusive aortoiliac disease. Seven (20 per cent) presented as acute surgical emergencies. Review of the records of the initial operations revealed that superficial wound infections with positive bacteriological cultures had been present in eight cases (23 per cent) and a further two (6 per cent) had lymph fistulae. Thirty-two false aneurysms were repaired, by simple reanastomosis in 14 cases, interposition grafting in 17 cases and in one case by complete revision to an aortobifemoral bypass graft. The risk of a further operative repair was less (P &lt; 0.05) following interposition grafting, than after simple revision. False aneurysm repairs, when compared with primary reconstructions done during the same period, were associated with more superficial wound infections (37 versus 10 per cent) and more explorations for haemorrhage within 30 days (19 versus 7 per cent).
Abdominal aortic aneurysm repair in the over eighties
Authors: Robson A K , Currie I C , Poskitt K R , Scott D J A , Baird R N , Horrocks M 
Published: March 2007

Abstract
Between January 1980 and September 1988, 34 octogenarians underwent aortic aneurysm repair. There were 26 men and eight women with a median age of 83 years (range 80–88 years). Twenty underwent ‘emergency’ repair after presenting with pain and/or collapse: 11 with a retroperitoneal rupture, three with an intraperitoneal rupture and six with an expanding aneurysm. The mortality rate for this group was 35 per cent. During the same period 14 patients had an elective repair and there were no deaths within 30 days. The mean hospital stay for the elective group was 14.2 days compared with 17.0 days for survivors in the emergency group. There was no significant difference in terms of risk factors between those who developed postoperative complications and those who did not. These mortality rates compare favourably with our overall mortality results for elective (4.6 per cent) and emergency (31 per cent) surgery. Those patients over 80 years of age with infrarenal abdominal aortic aneurysms should not be refused surgery on the basis of age alone; each patient should be judged individually.
Differential effects of low-dose tissue plasminogen activator and streptokinase on platelet aggregation
Authors: Berridge D C , Burgess-Wilson M E , Westby J C , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Despite increasing success with low-dose intra-arterial thrombolysis, early rethrombosis still occurs. Platelet aggregation is thought to play a major part in this process. We have therefore investigated the effects of recombinant tissue plasminogen activator (rt-PA) and streptokinase on platelet function at doses currently used for peripheral arterial thrombolysis. Platelet-rich plasma was stirred at 37°C, with either streptokinase (100, 300 or 1000 units ml−1) or rt-PA (10 (T10), 30 (T30) and 100 (T100) mg l−1), with immediate addition of an agonist for platelet aggregation (thrombin, collagen, adenosine diphosphate (ADP) or adrenaline) at a predetermined threshold dose. Significant inhibition of collagen-induced and adrenaline-induced platelet aggregation was produced with rt-PA at all doses used (P &lt; 0.05). With adrenaline as the agonist, T100 produced disaggregation to a mean(s.d.) level of 26 (11) per cent. Thrombin-stimulated platelet aggregation was significantly reduced by T100 (P &lt; 0.001) and T30 (P &lt; 0.01) only, disaggregation being dose-dependent and complete with T100. Using ADP as the agonist, T100 produced a significant reduction in maximum platelet aggregation (P &lt; 0.01), and disaggregation was achieved to a mean(s.d.) level of 48(13) per cent. Streptokinase did not produce any significant changes in any parameter of aggregation.
Complications of parotid surgery: The need for selectivity
Authors: Owen E R T C , Banerjee A K , Kissin M , Kark A E 
Published: March 2007

Abstract
The morbidity rate following 112 operations on the parotid gland is reported. Facial nerve palsy (temporary, 38 per cent; permanent, 9 per cent) and Frey's syndrome (11 per cent) were common following superficial parotidectomy. For pleomorphic adenoma and malignant lesions this procedure is justified. Benign conditions, which can be diagnosed preoperatively, should be treated by more limited surgery which has a lower complication rate.
Appendicectomy and carcinoma of the caecum
Authors: Armstrong C P , Ahsan Z , Hinchley G , Prothero D L , Brodribb A J M 
Published: March 2007

Abstract
A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group. The presence of synchronous carcinomas and/or adenomas was unrelated to previous appendicectomy. Ten patients presented with appendicitis and 11 with a mucocele of the appendix as the first sign of carcinoma of the caecum. Previous appendicectomy was associated with a higher incidence of local fixity, invasion of the abdominal wall, metastatic spread and poor differentiation. These differences were reflected in a significantly lower resection rate for carcinomas in patients who had previously undergone appendicectomy. The survival of patients who had previously had appendicectomy was significantly reduced. Four independent prognostic factors for survival were identified using multivariate discriminant analysis. These were Dukes' classification, local invasion, tumour differentiation and previous appendicectomy. Local recurrence was more common in patients who had previously had appendicectomy and was often in the old appendicectomy wound itself. Appendicectomy does not increase the risk of carcinogenesis in the caecum. In this study a history of appendicectomy was an independent risk factor for survival and significantly worsened the prognosis for patients who subsequently developed carcinoma of the caecum.
Anterior sphincter plication and levatorplasty in the treatment of faecal incontinence
Authors: Miller R , Orrom W J , Cornes H , Duthie G , Bartolo D C C 
Published: March 2007

Abstract
The surgical treatment of faecal incontinence has been traditionally divided into sphincteroplasty for sphincter disruption and postanal repair for idiopathic cases. However, many studies have failed to show a correlation between outcome and change in the anorectal angle. This study was carried out to determine the effectiveness of anterior sphincteroplasty and levatorplasty in the treatment of faecal incontinence, regardless of aetiology. Thirty consecutive patients underwent surgery, 14 with traumatic sphincter injuries and 16 with idiopathic faecal incontinence. A satisfactory clinical result was obtained in ten (71 per cent) patients in the traumatic group and in ten (62 per cent) in the idiopathic group. This was associated with a significant increase in maximum voluntary contraction pressure in the traumatic group and in those patients who had a good result in the idiopathic group (traumatic: preoperative median 80 cmH2O (range 50–115 cmH2O) versus postoperative 115 cmH2O (75–290 cmH2O), P&lt;0.005; idiopathic: preoperative 105 cmH2O (45–190 cmH2O) versus postoperative 120 cmH2O (45–230 cmH2O), P&lt;0.05; Wilcoxon paired signed ranks test). There was also a significant improvement in anal sensation in the upper anal canal in both groups (traumatic: preoperative mean 17 mA versus postoperative 11 mA, P&lt;0.05; idiopathic: preoperative 24 mA versus postoperative 9 mA, P &lt;0.02). The anorectal angle increased in the idiopathic group at rest (preoperative median 105° (range 86–152°) versus postoperative 118° (95–180°), P&lt;0.05). In conclusion, the type of approach (anterior or posterior) and the anorectal angle are irrelevant to the outcome of surgery for idiopathic faecal incontinence. Success appears to be related more to improved sphincter pressure and anal sensation.
Declining indications for abdominoperineal resection
Authors: Kirwan W O , O'Riordain M G , Waldron R 
Published: March 2007

Abstract
In 126 consecutive patients operated on for carcinoma of the lower two-thirds of the rectum, a consistent policy of sphincter preservation resulted in 100 (79 per cent) having anterior resection and 22 (17 per cent) abdominoperineal resection. Perioperative complications in the anterior resection group were: death (two patients), clinical leakage (three patients), pulmonary embolism (five patients), pelvic haematoma (one patient), small bowel obstruction (one patient) and wound sepsis (six patients). Of 55 patients who had a potentially curative anterior resection with follow-up of at least 2 years, one developed local recurrence. Five per cent of patients had significant continence problems. Low anterior resection for carcinoma is associated with low perioperative morbidity, satisfactory functional results and acceptable local recurrence rates.
Differential diagnosis of subungual melanoma from a surgical point of view
Authors: Shukla V K , Hughes L E 
Published: March 2007

Abstract
Subungual lesions referred to a surgical unit over a 17-year period have been reviewed to assess problems of differential diagnosis and management of suspected subungual melanoma. Such lesions are uncommon, even in a unit with interest in melanoma. Only four melanomas were seen for primary treatment, and eight in all, during the period. We describe the clinical features of other subungual lesions seen in surgical patients which might help in their differentiation from melanoma. Differential diagnosis and a management policy to achieve early diagnosis are discussed in the light of data from this series and study of the relevant literature.
Arteriogram scoring systems and pulse generated run-off in the assessment of patients with critical ischaemia for femorodistal bypass
Authors: Scott D J A , Hunt G , Beard J D , Hartnell G G , Horrocks M 
Published: March 2007

Abstract
Conventional arteriography is the investigation of choice in patients with critical ischaemia to select the site for the distal anastomosis of a femorodistal bypass. Several arteriographic scoring systems have been devised in an attempt to quantify the run-off. More recently Pulse Generated Run-off and intraoperative peripheral resistance measurements have been proposed as better predictors of early graft patency. Eighty-eight consecutive femorodistal bypass grafts were studied using Pulse Generated Run-off (PGR), conventional and intra-arterial digital subtraction arteriography (DSA) and peripheral resistance measurement. Three widely used arteriographic scoring systems were used to grade the arteriographic run-off. There were significant correlations between the scoring systems and the measured peripheral resistance, although PGR correlated better with peripheral resistance than arteriography (rs = −0·59, P &lt;0·001). Intra-arterial DSA improved the correlation between the arteriogram scoring systems and the measured peripheral resistance in the distal popliteal artery, but not in single calf vessels. In contrast, PGR correlated much better with peripheral resistance in single calf vessels (rs = −0·82, P0·001). We recommend that selection for femorodistal reconstruction be based on a combination of intra-arterial DSA and PGR. PGR will identify patent distal calf vessels not seen on arteriography and determine their continuity with the pedal arch, two features which are essential prerequisites for successful femorodistal bypass.
Serum enzymes and other laboratory tests in acute pancreatitis
Authors: Clavien P-A , Burgan S , Moossa A R 
Published: March 2007

Abstract
This review evaluates selective enzymes and blood tests available for the diagnosis and prognosis of acute pancreatitis. It is concluded that serum amylase and lipase measurements represent the best available diagnostic methods. Newer alternative assays still require careful evaluation.
Late complications of pancreatic trauma
Authors: Carr N D , Cairns S J , Lees W R , Russell B C G 
Published: March 2007

Abstract
Pancreatic trauma is rare and experience concerning its management is consequently limited. Lessons learnt in the investigation and treatment of a group of 11 patients (median age 28·0 years, range 14–44 years), who presented with the sequelae of trauma, are described. These patients were referred to a centre with an interest in pancreatic disease at a median time of 6·0 months (range 1·5–34 months) after blunt (n = 9) or penetrating (n = 2) injury to the pancreas. Ten of the 11 patients had undergone either single (n = 4) or multiple (n = 6) previous operations. Ten of the 11 patients had either strictures or disruptions of the main pancreatic duct demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (n = 8) or by exploration of the pancreas (n = 2). Satisfactory results were achieved by non-operative treatment in one patient and by distal pancreatectomy in eight. One further patient, who underwent distal pancreatectomy, later required completion resection because of unsuspected ductal injury in the head of the gland. The final patient continued with symptoms of pancreatitis after pancreaticoduodenectomy. It is concluded that the non-resolving sequelae of pancreatic trauma are associated with injury to the main pancreatic duct and that specialist investigation should be performed before surgical intervention is contemplated.
Ten-year review of non-ruptured aortic aneurysms
Authors: Mutirangura P , Stonebridge P A , Clason A E , McClure J H , Wildsmith J A W , Nolan B , Ruckley C V , Jenkins A McL 
Published: March 2007

Abstract
Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2·9 per cent. The mortality in patients undergoing elective surgery was 1·9 per cent (1·1 per cent in asymptomatic and 3·6 per cent in symptomatic patients) and 4·0 per cent for patients undergoing emergency surgery.
Protective effects of recombinant human tumour necrosis factor α and interferon γ against surgically simulated wound infection in mice
Authors: Hershman M J , Pietsch J D , Trachtenberg L , Mooney T H R , Shields R E , Sonnenfeld G 
Published: March 2007

Abstract
Tumour necrosis factor α and interferon γ have both been shown to have immunoregulatory properties, and to be able to influence several microbial infections. This study showed that tumour necrosis factor was effective in modifying surgically simulated wound infections when administered both as prophylaxis and as therapy. Two models were used; one was an intramuscular bacterial challenge, and the other involved the use of a bacteria-laden thigh suture. The test bacterium for both models was Klebsiella pneumoniae, a common surgical pathogen in our surgical service. Interferon γ was an effective biological response modifier in these models. Tumour necrosis factor was more potent than interferon γ and there was no additive or synergistic effect with interferon γ. This indicates potentially different mechanisms of action for these two cytokines.
Diurnal insulin and glucose profiles following transplantation of fresh and cryopreserved canine pancreatic islets
Authors: Walsh T N , Fitzpatrick J M , Alderson D , Alberti K G M M , Farndon J R 
Published: March 2007

Abstract
Dispersed islet autotransplants (fresh and cryopreserved) can produce normal fasting insulin and glucose concentrations. Following an intravenous glucose challenge, however, the insulin response is impaired and glucose clearance delayed. This study examines the diurnal insulin and glucose response to feeding in recipients of fresh islet autografts (n = 6), recipients of cryopreserved islet autografts (n = 3), normal unoperated controls (n = 10) and insulin treated pancreatectomized diabetic dogs (n=7). Mean fasting insulin and glucose levels were similar in all groups. After feeding, insulin profiles in both transplant groups were near normal while significant hyperinsulinaemia occurred in insulin treated diabetic dogs. Mild postprandial carbohydrate intolerance was observed in transplant recipients but glycosylated haemoglobin levels were similar (mean(s.d.)) to normals (6·88(0·86) per cent, 6·86(0·5) per cent respectively). Dispersed islet autotransplantation with portal insulin delivery produces near normal insulin and glucose profiles suggesting that this may represent a suitable treatment for insulin dependent diabetes.
Technical training in surgery: The trainee's view
Authors: Steele R J C , Logie J R C , Munro A 
Published: March 2007

Abstract
A questionnaire designed to investigate the technical training of general surgical trainees was distributed throughout Scotland. A total of 222 questionnaires were sent out and 179 (81 percent) were returned. Of the responders, 38 per cent felt that the overall operative workload was too small and the majority thought that there was too little emphasis on supervised operating. Two-thirds of trainees were generally satisfied with the amount of unsupervised operating, although a substantial proportion (21 per cent) sometimes felt out of their depth when performing delegated emergency operations. Few had attended craft workshops or travelled to other centres, but of those who had, most considered both activities to be very useful. Photographic atlases and videos were not generally felt to be of great value by those who had used them. The majority of trainees did not believe that research activity had interfered excessively with their technical training.
Gastrocolic fistula as a complication of benign gastric ulcer: Report of four cases and update of the literature
Authors: Soybel D I , Kestenberg A , Brunt E M , Becker J M 
Published: March 2007

Abstract
Four cases of gastrocolic fistula complicating benign gastric ulcer are described, bringing the total number of individually reviewed cases in the English language literature to 108. A review of 30 cases reported in the past 10 years reveals a surprisingly high percentage of young, female patients. Three-quarters of these patients used steroidal or nonsteroidal anti-inflammatory agents. The presence of such fistulae is suspected in patients complaining of weight loss, diarrhoea and faecal vomiting. Small fistulae may not be suspected when overshadowed by other complications of ulcer disease such as bleeding or perforated viscus. Medical management of benign gastrocolic fistulae may be indicated in some circumstances. Surgical treatment involves en bloc resection, including the fistula, and surrounding colon and gastric segments.
Protein electrophoresis of diagnostic peritoneal lavage in penetrating abdominal trauma: A marker of significant injury
Authors: McDonald M A , Muckart D J J 
Published: March 2007

Abstract
Protein electrophoresis of diagnostic peritoneal lavage fluid has been shown in experimental work to be a marker of hollow viscus injury. In order to ascertain the value of this investigation in penetrating abdominal trauma, we conducted a prospective study, over a 4-month period, involving 35 patients with stab wounds to the abdomen whose initial clinical examination was equivocal. The results of electrophoresis were compared with the standard quantitative criteria for diagnostic lavage and the operative findings. Protein electrophoresis was found to be a more sensitive and specific marker of significant intra-abdominal injury than the standard quantitative criteria.
Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors
Authors: Clarke Maureen P , Kane Robert A , Steele Glenn , Hamilton Edna S , Ravikumar Thanjavur S , Onik Gary , Clouse Melvin E 
Published: March 2007

Abstract
A prospective evaluation of the accuracy of preoperative computed tomography (CT), ultrasonography (US), and angiography was performed in 54 patients undergoing resection of hepatic neoplasms. The results were compared with surgical findings and intraoperative ultrasonography (IOUS). A total of 167 lesions was seen by means of IOUS, of which preoperative US enabled detection of 127 (76%). In 48 patients CT allowed detection of 91 of 150 lesions (61%), and in 35 patients angiography showed 56 of 107 lesions (52%). When the detection rate is analyzed according to hepatic segment, the greater overall accuracy of preoperative US may be attributed to a markedly better detection rate in lateral segment of the left lobe of the liver. Lesion size also represented a factor, with preoperative US allowing detection of a greater number of small (less than 2 cm) lesions compared with CT. In patients studied with both CT and US, the combined lesion-detection rate increased to 81% in the right lobe and 76% in the left lobe. Because of this we recommend that preoperative assessment include both CT and US evaluation of the liver. IOUS showed 25% to 35% additional lesions compared with preoperative US and CT. More importantly, 40% of the lesions demonstrated by IOUS were neither visible nor palpable at surgery. We recommend that IOUS be considered in all patients in whom resection of hepatic neoplasm is planned. (Surgery 1989;106:849-55).
From the Departments of Radiology and Surgery, New England Deaconess Hospital, Boston, Mass.