bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of adenocarcinoma of the cardia with synchronous chemotherapy and radiotherapy
Authors: Gill P G , Jamieson G G , Denham J , Devitt P G , Ahmad A , Yeoh E , Jones A M 
Published: March 2007

Abstract
Twenty-nine evaluable patients with adenocarcinoma of the cardia were treated with synchronously administered chemotherapy (two cycles of 5-fluorouradl and cisplatin and 30–36 Gy of radiation to determine whether these tumours are responsive to such treatment. Complete regression of tumour was observed endoscopically in 19 patients, and partial regression in four. Fourteen patients had their tumours resected and in six no microscopic tumour was found in the specimen. Nine patients received additional radiotherapy to a total dose of 54–60 Gy instead of surgery. Tumour response was associated with rapid reversal of dysphagia. Only one patient required subsequent intervention for relief of dysphagia due to fibrous stricture. Enhanced survival was associated with a complete endoscopic response to initial chemotherapy and radiotherapy, and a tumour of &lt; 5 cm in length. The median survival of responding patients was 15 months. Synchronous chemotherapy and radiotherapy was of major palliative benefit in this series and merits further evaluation.
Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer
Authors: Bassotti G , Gullà P , Betti C , Whitehead W E , Morelli A 
Published: March 2007

Abstract
Total gastrectomy with Roux-Orr anastomosis is frequently performed for gastric cancer. Since intestinal motility of the Roux limb has never been evaluated after this operation, pressure activity was investigated in the Roux limb of ten patients (aged 51–77 years) who had undergone total gastrectomy and Roux-Orr reconstruction. Investigations were carried out during a 6-h fast and 3 h after a 605 kcal mixed meal. During fasting only two patients had activity fronts and these were abnormal. All ten patients displayed non-propagating bursts of contractions and three had discrete clustered contractions and high amplitude jejunal contractions. The fed state was characterized by a severely reduced motor activity pattern and other abnormalities. Total gastrectomy with Roux-Orr anastomoses provokes a relatively severe disturbance in intestinal activity.
Single lumen ileum with myectomy: A possible alternative to the pelvic reservoir in restorative proctocolectomy
Authors: Sagar P M , Holdsworth P J , King R F G J , Salter G , Johnston D 
Published: March 2007

Abstract
An alternative procedure to construction of a pelvic ileal reservoir was assessed which avoids the need for a pouch, while providing an adequate rectal substitute and good continence. Thirty-six female adult beagles were allotted randomly to undergo total colectomy with (a) ileo—anal anastomosis alone, (b) ileo-anal anastomosis with two 15 cm myectomies, (c) ileo-anal anastomosis and myectomy with an ileo-ileal valve, or (d) ileo-anal anastomosis with a duplicated J pouch. The animals were studied before operation and at 4-weekly intervals for 20 weeks after operation. Mortality rates were similar. Ileal compliance was increased significantly by myectomy from 0·64 ml/mm Hg (median, interquartile range 0·49–0·78) after ileo-anal anastomosis alone to 1·65 mmHg (1·16–1·93), P &lt; 0·01, an increase which was maintained. Heal capacity was also increased both by myectomy and by the J pouch: ileo-anal anastomosis = 85 ml (75–100 ml), ileo-anal anastomosis and myectomy = 139 ml (116–156 ml), ileo-anal anastomosis and myectomy and ileo-ileal valve = 125 ml (range 85–145 ml), ileo—anal anastomosis and J pouch = 130 ml (range 75–165 ml) (P &lt; 0·01). Bowel function in the other three groups was markedly superior to ileo—anal anastomosis alone. Mean transit time was significantly less after ileo—anal anastomosis, 5·2 h (2·6–8·2 h) than after both ileo—anal anastomosis and myectomy, 10·5 h (9·6–13·9 h), P &lt; 0·05 and ileo-anal anastomosis and J pouch, 11·0 h (8·4–13·0 h), P &lt; 0·05, but addition of an ileo-ileal valve did not produce a further increase in transit time, 12·9 h (range 10·5–14·5 h), P = n.s‥ Myectomy of single lumen ileum may be a useful alternative to a pelvic Heal reservoir in restorative proctocolectomy.
Elective resection for diverticular disease of the sigmoid colon
Authors: Moreaux J , Vons C 
Published: March 2007

Abstract
From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 5 2 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.
Gracilis muscle transposition for faecal incontinence
Authors: Christiansen J , Sørensen M , Rasmussen O Ø 
Published: March 2007

Abstract
Transposition of the gracilis muscle for faecal incontinence was performed in 13 patients. Six gained satisfactory continence, four were improved, two did not benefit from the operation and one patient died from intercurrent disease before closure of a pre-existing colostomy. Anal manometry compared with a control group showed no alteration in resting anal pressure at a median of 35 mmHg (range 5–63 mmHg), whereas maximum squeeze pressure increased from a median of 38 mmHg (range 5–79 mmHg) to 59 mmHg (range 10–143 mmHg) (P = 0·041) which was, however, significantly lower than 130 mmHg (range 81–236 mmHg) in the control group. All patients who benefited from the operation had an increase in maximum squeeze pressure. The ability to retain a viscous fluid in the rectum was measured in seven patients, four of whom had gained satisfactory continence and three of whom had improved continence. They were able to retain a median volume of 200 ml (range 50–225 ml) without leakage compared with 325 ml (range 250–400 ml) in the control group. These patients could retain the maximum amount of viscous fluid for 5–8 min, whereas all control subjects could do so for more than 15 min. It is concluded that, although gracilis transposition never results in normal continence, acceptable continence may be achieved in selected patients provided careful attention is paid to the technical details of the procedure and provided that systematic postoperative exercises are performed.
Survey of the use of thrombolysis for acute limb ischaemia in the UK and Ireland
Authors: Earnshaw J J , Shaw J F L 
Published: March 2007

Abstract
A total of 156 vascular surgeons from the UK and Ireland responded to a postal questionnaire on the use of thrombolysis in acute limb ischaemia. Almost half had used thrombolysis in the previous 12 months. Low dose intra-arterial streptokinase (89 per cent) was the regimen most frequently used, but 33 per cent had used intravenous streptokinase. Detailed results for 103 patients (limb salvage rate 60 per cent, amputation rate 35 per cent, mortality rate 5 per cent) were similar to those of previously published reports. Complications in most series were infrequent, but in the entire survey there were six bleeding-related deaths and one death from anaphylaxis. A total of 67 per cent of surgeons with working experience indicated that selected patients with acute arterial thromboses were most suitable for thrombolysis, particularly if there was no neurological deficit and no run-off for surgical bypass. Distal or late emboli and graft occlusions were regarded as appropriate by some surgeons. This study demonstrated that many vascular surgeons currently use thrombolysis, although sparingly and in selected cases. Patients with acute limb ischaemia should be managed by experienced vascular surgeons who are aware of the new therapeutic alternatives, an ideal supported by almost three-quarters of respondents to this survey.
Intraoperative air testing of colorectal anastomoses: A prospective, randomized trial
Authors: Beard J D , Nicholson M L , Sayers R D , Lloyd D , Everson N W 
Published: March 2007

Abstract
A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to ‘test’ or ‘no test’ once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to ‘test’ and 71 to ‘no test’ but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the ‘test’ group. After operation there were three (4 per cent) clinical leaks in the ‘test’ group and ten (14 per cent) in the ‘no test’ group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the ‘test’ group and 20 (29 per cent) in the ‘no test’ group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.
Malignant left-sided large bowel obstruction managed by subtotal/total colectomy
Authors: Stephenson B M , Shandall A A , Farouk R , Griffith G 
Published: March 2007

Abstract
Of 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on-table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P &lt; 0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P&lt;0.05). All three patients who had on-table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results.
Blood transfusion and recurrence of colorectal cancer: The role of platelet derived growth factors
Authors: Lawrance R J , Cooper A J , Loizidou M , Alexander P , Taylor I 
Published: March 2007

Abstract
Efforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion. However, the relationship between solid tumour development and the immune system is inconclusive. We have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon. Using a human fibroblast: [125I]deoxyuridine uptake mitogenesis assay, the relative amounts of growth factor in the plasma of stored blood were measured. There was a progressive increase in mitogenesis from day 0 (n = 6) to day 28 (n = 6; P&lt; 0.001, Mann-Whitney U test). The effect of growth factors on the development of liver and intraperitoneal metastases was studied in Hooded Lister fats. Following an intraportal injection of 105 MC28 tumour cells, the experimental group (n = 25) received 2 ml of syngeneic serum intravenously for 4 days. Likewise, colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 103 cells. The experimental groups (n = 20) received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally (n = 19). There was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group (P&lt;0.01). Growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cancer.
Mastalgia refractory to drug treatment
Authors: Gateley C A , Maddox P R , Mansel R E , Hughes L E 
Published: March 2007

Abstract
Management of the patient with mastalgia who fails to respond to first line therapy is a difficult problem and there is a group of patients who do not respond to any therapy. A group of 126 patients with mastalgia who failed to respond to first line therapy and completed further treatment options was studied. The response rate of those with cyclical mastalgia fell to 57 and 25 per cent for second and third line therapy respectively. Equivalent figures for non-cyclical mastalgia were 24 and 21 per cent. Danazol maintains a high response rate after the failure of other drugs, whereas the second line response to bromocriptine and evening primrose oil is poor. Unresponsive patients were matched to a group of patients who responded to first line therapy, and reproductive and historical factors were compared using the x2 test, but failed to identify which patients would respond to therapy.
Pulse oximetry: A new non-invasive assessment of peripheral arterial occlusive disease
Authors: Joyce W P , Walsh K , Gough D B , Gorey T F , Fitzpatrick J M 
Published: March 2007

Abstract
Peripheral skin perfusion reflects the level of vascularity and viability of a limb and may help in planning the site of amputation or bypass surgery in patients with vascular disease. This study used peripheral pulse oximetry in 20 healthy volunteers and in 20 patients with limb ischaemia. Pulse oximetry saturation levels (Psa,O2) were compared with ankle artery Doppler pressures and transcutaneous oxygen measurements (Ptc,O2)- Recordings were taken at two standard sites distally and referenced to finger and forearm to calculate an index. A significant correlation was found between Ptc,O2 and Psa,o2 in patients with ischaemia (r = 0.68, P&lt;0.01). A further group of 12 patients with acute limb ischaemia was similarly assessed before and after revascularization. After revascularization mean(s.d.) Ptc,O2 increased from 38(13) to 44(1) mmHg (P&gt;0.05) and mean(s.d.) Psa,O2 increased from 86(3) to 90(4) per cent (P&lt;0.01). These data suggest that pulse oximetry is a more sensitive index of peripheral perfusion than Ptc,O2 or ankle artery Doppler pressure and that, because of its accuracy and simplicity, it merits further use.
Graft stenosis: Justification for 1-year surveillance
Authors: Taylor P R , Wolfe J H N , Tyrrell M R , Mansfield A O , Nicolaides A N , Houston R E 
Published: March 2007

Abstract
In all, 412 femorodistal grafts (femoropopliteal and femorocrural), performed between 1984 and 1988, have been prospectively studied at 6 weeks and 3, 6, 9 and 12 months after operation and at intervals of 6 months thereafter by duplex scanning and intravenous digital subtraction angiography. The overall incidence of stenoses was 16 per cent (femorocrural 20 per cent, femoropopliteal 15 per cent). All stenoses were detected in the first year after operation and none occurred after this. Twenty-four non-haemodynamically significant stenoses were not treated but were followed at intervals of 3 months. Forty-two haemodynamically significant stenoses were detected and secondary procedures were performed in 30 grafts at a mean of 8 months after surgery. Thirteen had percutaneous balloon dilatation and six (46 per cent) remain patent at a mean follow-up of 22 months. Two grafts which occluded within 30 days and three which restenosed at a mean of 8 months had tertiary procedures. Seventeen grafts were surgically revised, nine with patch grafts and eight with bypass grafts. Eleven of these remain patent at a mean follow-up of 30 months. One occluded immediately and three occluded late. Two grafts which restenosed at a mean of 19 months had successful tertiary procedures. In total, seven grafts had tertiary procedures (two had balloon dilatation and five had surgery) and six of these remain patent at a mean follow-up of 13.5 months. In conclusion, 37 procedures have been performed on 30 grafts, of which 23 (77 per cent) remain patent at a mean follow-up of 12 months. Approximately one-quarter of femorodistal grafts will develop graft-related stenoses and graft surveillance is worthwhile, but only for the first year after operation.
Recent changes in the treatment of aortoiliac occlusive disease by the Oxford Regional Vascular Service
Authors: Davies A H , Ramarakha P , Collin J , Morris P J 
Published: March 2007

Abstract
Over the four years from 1 January 1985 to 31 December 1988, 192 patients were treated for aortoiliac occlusive disease by the Oxford Regional Vascular Service. The number of patients treated by percutaneous transluminal angioplasty increased from two in the first year of the study to 34 in the third year of the study. This increase was accompanied by a decrease in the proportion of patients treated by aortobifemoral bypass but the proportion of patients treated by extra-anatomic bypass remained constant at around 30 per cent. Twice as many patients were treated in the fourth year as in the first year of the study so that the number of surgical operations increased despite many patients being treated exclusively by percutaneous transluminal angioplasty. The number of patients requiring mandatory treatment for limb salvage increased by 109 per cent and optional treatment for intermittent claudication by 85 per cent. The introduction of percutaneous transluminal angioplasty in Oxford has coincided with an increase in the number of patients presenting with symptomatic aortoiliac occlusive disease and has allowed twice as many people to be treated while the number of aortobifemoral bypass operations has remained unchanged. It is concluded that the introduction of percutaneous transluminal angioplasty has not only generated its own workload but has also led to an increased demand for surgical reconstruction for aortoiliac occlusive disease.
Conservative management of asymptomatic popliteal aneurysm
Authors: Bowyer R C , Cawthorn S J , Walker W J , Giddings A E B 
Published: March 2007

Abstract
Historical review shows that the treatment of popliteal aneurysm has developed by trial and error and there is disagreement about the proper management of the symptomless patient. In 1981 a policy of conservative management for asymptomatic popliteal aneurysm was adopted in this unit. Since that time we have also managed nine patients with thrombosed popliteal aneurysms by arteriography and low-dose intra-arterial streptokinase. Six patients treated within 72 h of occlusion achieved significant (70–100 per cent) lysis, but streptokinase was ineffective in those treated 10 or more days after the thrombosis. Of the six patients with significant lysis, three were treated by elective reconstruction and two by anticoagulation. One patient who had significant lysis died. Vascular patency of all five successfully treated limbs was maintained and no limb loss occurred in those who presented late and failed to achieve significant lysis. These results reinforce the view that thrombolysis is the treatment of choice for thrombosed popliteal aneurysms. The low complication rate for asymptomatic popliteal aneurysm and the advent of safe, effective thrombolysis indicate that operation for symptomless popliteal aneurysm is no longer required.
Acute limb ischaemia: The place of intravenous streptokinase
Authors: Earnshaw J J , Cosgrove C , Wilkins D C , Bliss B P 
Published: March 2007

Abstract
Intravenous streptokinase infusions (100 000 units/h) have been used to treat 48 patients, with 50 episodes of acute limb ischaemia who were unlikely to benefit from a surgical approach. These included 17 acute thromboses, 14 late or distal emboli and 19 bypass graft occlusions. Overall, 17 (34 per cent) instances had complete lysis with reappearance of distal pulses and a further 28 per cent had clinical improvement without change in pulse status. Final outcome after 30 days was limb salvage in 60 per cent, amputation in 24 per cent and death in 16 per cent, but this was achieved after eight patients without lysis had vascular reconstructive surgery. Serious complications were infrequent, but included a fatal stroke, a haematemesis and two episodes of distal embolization. The outcome was not related to the duration of ischaemia or the site of occlusion. Lysis was more frequent with emboli (50 per cent) and graft occlusions (47 per cent) than arterial thromboses (6 per cent). Limb salvage was more likely in patients with no neurological deficit in the limb (70 per cent) than if a deficit was present (37 per cent). In conclusion, intravenous streptokinase produced a moderate benefit with low morbidity and has a role in acute limb ischaemia if surgery is inappropriate and intra-arterial lysis unavailable. In particular, selected patients with emboli or graft occlusions without a neurological deficit may be most suitable.
Trauma centres and the efficient use of financial resources
Authors: O'Kelly T J , Westaby S 
Published: March 2007

Abstract
The economic aspects of trauma centres were examined using published results and local financial data to discover if such institutions are an efficient use of resources. The cost of trauma centre care depends upon the number of centres built. An ‘ideal’ system in the UK of eight centres will cost £31268 per life saved compared with £45 661 for the system proposed by the Royal College of Surgeons of England. Trauma centre care will be expensive but will generate benefits in return. Survivors will be young (mean age 30 years) and most (70–80 per cent) will regain their pre-injury functional/work status. When considered in terms of Quality Adjusted Life Years (QUALYs), trauma centres are a relatively efficient use of resources. An expected cost per QUALY of £942–1376 is inexpensive compared with many health pursuits currently funded within the UK National Health Service.
Stress in surgeons
Authors: Green A , Duthie H L , Young H L , Peterst T J 
Published: March 2007

Abstract
A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.