bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic common bile duct exploration: Evolution of a new technique
Authors: Khoo D E , Walsh C J , Cox M R , Murphy C A , Motson R W 
Published: March 2007

Abstract
Laparoscopic exploration of the common bile duct (CBD) with a choledochoscope or a stone basket during laparoscopic cholecystectomy was attempted in 60 patients and was successful in 56. The cystic duct was used for entry to the CBD in 46 patients and in 14 a choledochotomy was performed. Of 51 patients with confirmed common duct stones, 38 had complete laparoscopic clearance (75 per cent). In 13 patients the duct was not cleared or was only partially cleared, of whom four went on to have clearance by postoperative percutaneous choledochoscopy down a cystic duct or T-tube track. Two patients with cystic duct tubes passed their remaining stones spontaneously. One patient had open exploration and six required endoscopic retrograde cholangiopancreatography. Of nine patients without stones, choledochoscopy was impossible in three patients whose cholangiogram was later considered to be normal. In five patients stones were excluded by choledochoscopy and in one patient laparoscopic choledochoscopy was undertaken to better define abnormal biliary anatomy; this helped to avoid major bile duct injury. Choledochoscopy was easier with the smaller 3·6-mm ureteroscope but stone removal was more difficult when the basket was too small for the stones, the cystic duct too small relative to stone size or the number of stones was too great. Successful stone clearance was proportional to the level of effort expended, and was limited by operating time and equipment.
Results from pouch salvage
Authors: Korsgen S , Nikiteas N , Ogunbiyi O A , Keighley M R B 
Published: March 2007

Abstract
Over an 11-year period, 17 salvage procedures were performed on a failed ileal pouch-anal anastomosis carried out for ulcerative colitis from a series of 157 patients. Ten pouches were saved, four excised and three defunctioned. Salvage procedures included five operations for fistulas (three of five successful), six reoperations on the ileoanal anastomosis (five of six successful), three new pouches after previous pouch excision (all failed), and three miscellaneous: excision of an efferent limb (successful), pouchpexy for a pouch prolapse (successful) and postanal repair for incontinence (failed). Pouch salvage may be successful in the motivated patient who wishes to avoid a permanent ileostomy.
Technique for full-thickness muscle closure of laparoscopic port sites
Authors: Robertson G S M , Lloyd D M , Kelly M J , Veitch P S 
Published: March 2007

Abstract
Since the introduction of laparoscopic surgery there have been several case reports of incisional hernia at sites where laparoscopic trocars have been inserted through the abdominal wall1–5. These occur predominantly through port sites with a diameter of 10 mm or more, either through the linea alba at the umbilicus, or through more lateral defects. Fascial closure reduces the incidence but does not eliminate hernias entirely as they can occur into the subfascial space1,2. As complex laparoscopic surgery involving the use of several large ports becomes increasingly common, the incidence of this complication is likely to increase. The authors believe it is important to perform a full-thickness closure of all muscle defects 10 mm or greater in diameter.
Removal of circulating cytokines by continuous haemofiltration in patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome
Authors: Wakabayashi Y , Kamijou Y , Soma K , Ohwada T 
Published: March 2007

Abstract
High continuous levels of plasma circulating cytokines have been reported in patients with systemic inflammatory response syndrome (SIRS)1. Such patients either produce excessive amounts of cytokines or cannot clear them from the circulation, and have been suggested to be at an increased risk of developing multiple organ dysfunction syndrome (MODS)2. In this context, cytokine removal may prevent the development of MODS. A study was therefore made of the effects of continuous haemofiltration (CHF) on blood levels of circulating cytokines and on pulmonary, cardiovascular or renal function in patients with SIRS or MODS.
Correlation between acute physiology and chronic health evaluation (APACHE) III score and immunological parameters in critically ill patients with sepsis
Authors: Rogy M A , Oldenburg H S A , Coyle S , Trousdale R , Moldawer L L , Lowry S F 
Published: March 2007

Abstract
A relationship between physiological parameters of severe sepsis and immunological function has not been established. In ten severely ill patients with sepsis physiological risk was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) III score, while one component of immunological function was evaluated using peripheral blood mononuclear cell (PBMC) cytokine production after stimulation with lipopolysaccharide (LPS) in vitro. Five of the ten patients died. Mean(s.e.m.) APACHE III scores at admission were not significantly different between survivors and non-survivors (82(13) versus 95(13)) but after 72 h they were lower in survivors (51(13) versus 111(15), P &lt; 0·05). Downregulation of cytokine production by PBMC on LPS stimulation was a transient event in survivors. Survivors had a three-fold increase in tumour necrosis factor α bioactivity within 72 h, but there was no increase in non-survivors. A similar pattern was demonstrated for interleukin (IL) 1β (P &lt; 0·05 between survivors and non-survivors) and IL-6 (P = 0·06) immunoactivity. Physiological as well as immunological parameters in critically ill patients with sepsis independently predicted hospital survival (r2 = 0·2). These data demonstrate a relationship between the pattern of cytokine production in vitro and survival.
Antioxidant depletion during aortic aneurysm repair
Authors: Khaira H S , Maxwell S R J , Thomason H , Thorpe G H G , Green M A , Shearman C P 
Published: March 2007

Abstract
Ischaemia–reperfusion injury generates oxygen-derived free radicals leading to local and distant damage. A simple method of following oxidative activity is to measure the consumption of endogenous scavenging antioxidants; an enhanced chemiluminescent assay was used to study this phenomenon in 21 patients undergoing surgery for abdominal aortic aneurysm (AAA). Samples of peripheral venous blood were taken before induction of anaesthesia and then from a central venous line and the inferior mesenteric vein before, during, and after clamping of the aorta. Further specimens were taken from the central line at 2, 6 and 24 h after operation. Antioxidant concentration in the peripheral, central and inferior mesenteric blood were similar, indicating that anaesthesia and surgical dissection had no effect. Levels decreased significantly in central and inferior mesenteric blood during and after clamping, but returned to normal by 24 h. These results confirm ischaemia-reperfusion phenomena in AAA repair.
Radical surgery for advanced gallbladder carcinoma
Authors: Miyazaki M , Itoh H , Ambiru S , Shimizu H , Togawa A , Gohchi E , Nakajima N , Suwa T 
Published: March 2007

Abstract
Forty-four patients with advanced gallbladder carcinoma (18 with stage pT3 and 26 with stage pT4 of the Union Internacional Contra la Cancrum classification) were aggressively managed by extended heptatic resection in 33 patients, bile duct resection in 28, pancreaticoduodenectomy in seven, gastrointestinal resection in eleven and portal vein resection and reconstruction in seven. Adjacent organ involvement was classified as follows: type I, hepatic involvement with or without gastrointestinal invasion (Ia, Ib); type II, bile duct involvement with or without gastrointestinal invasion (IIa, IIb); type III, hepatic and bile duct involvement with or without gastrointestinal invasion (IIIa, IIIb); type IV, gastrointestinal involvement without hepatic or bile duct invasion. Fourteen of 15 patients with type I tumours had a curative resection compared with seven of 26 with type III lesions (P &lt; 0·0001). The surgical mortality rate was two of 15 patients with type I tumours, seven of 26 with type III tumours and nine of 44 for the whole group. The long-term survival rate after curative resection was four and two of 23 at 3 and 5 years respectively, significantly better than two and none of 21 at 1 and 2 years after non-curative resection (P &lt; 0·01). The survival rate after curative resection for patients with type I tumours was four and two of 14 at 3 and 5 years respectively, significantly better than for other types (P &lt; 0·05). This classification of advanced gallbladder carcinoma according to involvement of adjacent organs might be helpful in planning surgery for this condition; in particular, type I tumours should be treated by a radical surgical procedure to achieve a favourable outcome.
Nitric oxide and the rectoanal inhibitory reflex: Retrograde neuronal tracing reveals a descending nitrergic rectoanal pathway in a guineapig model
Authors: Stebbing J F , Brading A F , McC Mortensen N J 
Published: March 2007

Abstract
Nitric oxide has been implicated as the neurotransmitter mediating internal anal sphincter (IAS) relaxation during the rectoanal inhibitory reflex. However, there has been no direct demonstration of a nitrergic rectoanal neuronal pathway appropriate to mediating the reflex. This study combined retrograde neuronal tracing techniques with enzyme histochemistry in a guinea-pig model. Wheatgerm agglutinin conjugated to horseradish peroxidase was injected into the IAS. Transported tracer was demonstrated in neurones of the myenteric ganglia of the distal rectum and all labelled neurones showed co-localization with nitric oxide synthase as revealed by reduced nicotinamide adenine dinucleotide phosphate diaphorase histochemistry. In vivo anal canal manometry showed that the mean maximal resting pressure was 16 (8–20) cmH2O and confirmed the presence of the rectoanal inhibitory reflex. In vitro organ bath studies showed that strips of IAS developed spontaneous myogenic tone and relaxed in response to intrinsic nerve stimulation. Addition of Nω-nitro-l-arginine (l-NOArg) reduced the relaxant response in a dose-dependent fashion; the relaxant response was maximally reduced by a mean(s.e.m.) 35·2(3·8) per cent (P &lt;0·001) at a concentration of 3 × 10−5 mol/l l-NOArg. This study provides direct anatomical evidence of a descending nitrergic rectoanal neuronal pathway in a guinea-pig model. In vivo anal manometry and in vitro organ bath studies provide additional evidence that this pathway is responsible for the inhibitory motor innervation of the rectoanal inhibitory reflex.
Physiological and clinical outcome of anterior sphincteroplasty
Authors: Oliveira L , Pfeifer J , Wexner S D 
Published: March 2007

Abstract
A total of 55 women underwent sphincteroplasty for the treatment of faecal incontinence related to anterior defects. Patients were followed prospectively for a mean of 29 months to evaluate the outcome overall and according to age. All patients were evaluated clinically by means of a questionnaire and graded using an incontinence scoring system ranging from 0 (perfect continence) to 20 (complete incontinence). Some 52 patients (95 per cent) had had a previous vaginal delivery and 30 (55 per cent) had a history of previous anal sphincter repair. Physiological and functional parameters in patients with a successful outcome (n = 39) were compared with those in patients with a poor outcome (n = 16). The results were also compared in patients under (n = 39) and over (n = 16) 60 years of age. Overall, patients with a successful outcome had a significant change in mean and maximal resting and squeeze pressures. These changes correlated well with the increase in the high-pressure zone (HPZ) length from 1·0–2·2 cm (P = 0·0002) and with functional outcome (change in incontinence score from 15·3 to 5·8; P &lt; 0·0001). In patients over 60 years of age, a significant change in mean squeeze pressure (P = 0·03) and HPZ length (P = 0·01) was noted and correlated with functional outcome (change in incontinence score from 14·3 to 6·4; P &lt; 0·0001). A successful outcome after anterior sphincteroplasty is related to improvement in sphincter function even in an older population. These results demonstrate that age itself does not seem to be a predictor of poor outcome. Patients should not be denied a repair exclusively on grounds of age.
Transient rise in intact parathyroid hormone concentration after surgery for primary hyperparathyroidism
Authors: Tisell L-E , Jansson S , Nilsson B , Lundberg P A , Lindstedt G 
Published: March 2007

Abstract
Two-site immunometric assays for determination of the level of intact parathyroid hormone (PTH) in serum have enabled detailed clinical studies of PTH secretion. Fifty- one patients with primary hyperparathyroidism were studied before surgery and 2 years after operation. PTH levels dropped to low values after operation. A rebound increase in PTH concentration occurred from 10 days to 3 months after surgery. Abnormally raised postoperative PTH concentrations were noted in 31 per cent of the patients, who had lower serum concentrations of ionized calcium (Ca2+) than the rest (P &lt; 0·003). Before operation these patients had a more pronounced hyperparathyroidism than the others. At 2 years after surgery there was still a positive correlation between PTH concentrations before and after surgery (P &lt; 0·001). The rebound increase in the level of PTH was a general phenomenon probably caused by low Ca2+ concentrations at the time of remineralization of bone. This phenomenon was transient. The positive correlation between preoperative and postoperative PTH concentrations shows that effects of hyperparathyroidism can remain for a long time after surgical cure.
Colorectal cell kinetics
Authors: Gilliland R , Williamson K E , Wilson R H , Anderson N H , Hamilton P W 
Published: March 2007

Abstract
The assessment of cell proliferation in colorectal tissue may provide information with both prognostic and therapeutic implications. A variety of methods are available, including flow cytometric estimations of S phase fraction, immunohistochemical and autoradiographic visualization of exogenous and endogenous proliferation proteins, and morphological and stathmokinetic techniques. There is some correlation between Dukes stage and proliferation state features, and there is increased proliferative activity throughout the adenoma–carcinoma sequence. Data on cell proliferation rates are difficult to obtain. When correctly applied, the metaphase arrest technique remains the ‘gold standard’ of measuring proliferation, but its usefulness in clinical practice is limited. Recent studies have employed dual measurement flow cytometry and double labelling techniques to produce rate data.
Severe complications of perianal sepsis in patients with human immunodeficiency virus
Authors: Consten E C J , Slors J F M , Danner S A , Sars P R A , Obertop H , van Lanschot J J B 
Published: March 2007

Abstract
Fifty human immunodeficiency virus (HIV)-infected patients with perianal sepsis were studied. Seven (14 per cent) had serious septic complications, four patients with severe necrotizing gangrene, and three with abscesses in the mediastinum, liver and brain respectively. CD4 + lymphocyte counts were significantly lower in patients with severe septic complications as compared with those with uncomplicated perianal sepsis (P&lt;0·05). In patients with HIV presenting with rare (metastatic) abscesses, perianal sepsis must always be kept in mind as a possible focus. Although HIV-infected patients have a limited life expectancy perianal fistulas and abscesses should be aggressively treated, because of the high risk of severe complications.
Blood flow in the lower limb after balloon angioplasty of the superficial femoral artery
Authors: Hussain S T , Smith R E , Clark A L , Wood R F M 
Published: March 2007

Abstract
Using duplex ultrasonography lower-limb blood flow measurements were obtained in 20 patients with intermittent claudication. Assessments of flow were made in the common femoral artery, profunda femoris artery (PFA) and superficial femoral artery (SFA) before and after angioplasty for stenoses of short segments of the SFA. Blood flow was measured at rest and after exercise on a cycle ergometer. Collateral flow was calculated using an established mathematical model. Results were compared with the ankle: brachial systolic pressure index (ABPI) after exercise. Although there was no overall increase in resting limb blood flow, an increase in mean(s.d.) SFA flow from 148(79) to 312(94) ml min−1, with a concomitant decrease in PFA flow from 224(84) to 98(43) ml min−1 was noted 1 week after angioplasty (P&lt;0·05). At rest there was an increase in mean(s.d.) ABPI from 0·62(0·12) to 0·89(0·23) (P&lt;0·05). Collateral flow was estimated to have decreased from 186(34) to 18(8) ml min−1; the pattern of change in flow was similar after exercise. Angioplasty of the SFA remains controversial because of the risk of restenosis. The above methodology allows assessment of whether patients can re-establish collateral flow or whether limb blood flow will be significantly compromised if restenosis occurs.
An evaluation of the POSSUM surgical scoring system
Authors: Whiteley M S , Prytherch D R , Higgins B , Weaver P C , Prout W G 
Published: March 2007

Abstract
POSSUM (Physiological and Operative Severity Score for the enumeration of Morbidity and mortality) has been studied as a possible surgical audit system for a 9-month interval using a sample of 28 per cent of the general surgical workload. Mortality or survival was analysed as an endpoint. In this sample the published POSSUM predictor equation for mortality overpredicted deaths by a factor of more than two. The bulk of the overprediction occurred in the group at lowest risk (predicted mortality 10 per cent or less), in which death was overpredicted by a factor of six. This is the most important group for audit purposes since it contains the majority of surgical patients and is composed of fit patients undergoing minor surgery. The published predictor equation for mortality returns a minimum predicted mortality of 1·08 per cent, clearly far higher than that expected for a fit patient having minor surgery. Logistic regression was done on a set of 1485 surgical episodes to generate a local predictor equation for mortality. This process gave a predictor equation that fitted well with the observed mortality rate and gave a minimum predicted risk of mortality of 0·20 per cent. The previously published POSSUM predictor equation for mortality performed badly when tested using a standard test of goodness of fit for logistic regression and must be modified.
Parathyroidectomy in the West Midlands
Authors: Ready A R , Sabharawal T , Barnes A D 
Published: March 2007

Abstract
A retrospective audit was made of 101 patients undergoing parathyroidectomy, performed by 20 general surgeons in the West Midlands region during 1992. The mean number of cases per surgeon was five; nine surgeons performed fewer than three parathyroidectomies. Some 57 patients had primary hyperparathyroidism. Only seven were diagnosed by general practitioners and referral was invariably to a non-endocrine physician. Delay between diagnosis and surgical referral exceeded 2 years in 12 patients. Four patients (7 per cent) with primary hyperparathyroidism remained hypercalcaemic after first exploration; all were operated on by surgeons who performed fewer than four parathyroidectomies per year. Minor complications occurred in 32 per cent of patients. All 44 patients with renal hyperparathyroidism were treated in specialist units where diagnosis and treatment were expeditious; parathyroidectomy was successful in 41. Hyperparathyroidism should be managed in specialized units and by surgeons who perform parathyroidectomy frequently. A heightened awareness of primary hyperparathyroidism is required at primary care level.
Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux
Authors: Lundell L , Abrahamsson H , Ruth M , Rydberg L , Lönroth H , Olbe L 
Published: March 2007

Abstract
The importance of the extent of the fundic wrap that encircles the distal oesophagus for the establishment of long-term control of gastro-oesophageal reflux disease (GORD) and for the risk of symptoms after fundoplication was evaluated in a prospective, randomized clinical trial. Of 137 consecutive patients with GORD, 72 were allocated to a semifundoplication (180–200°, Toupet) and 65 to a total fundoplication (360°, Nissen–Rossetti). Dysphagia was more common in the early postoperative period after a total fundic wrap, a difference which disappeared with time. This corresponded to a higher resting tone in the lower oesophageal sphincter area. Seven patients (5 per cent) experienced relapse of GORD during follow-up of more than 3 years. Although no difference in the cumulative relapse rate (5 per cent for Nissen–Rossetti versus 6 per cent for Toupet) was found between the two study groups, the total failure rate was higher (P&lt;0·05) among patients who had a Nissen-Rossetti procedure because of a procedure-specific complication: intrathoracic herniation of the fundoplication in five patients caused obstructive symptoms without reflux (four had no posterior crural repair). In addition, symptoms in the form of flatulence were more frequently seen after Nissen-Rossetti fundoplication (P&lt;0·05 at 2 years and P&lt;0·01 at 3 years). Both Nissen–Rossetti and Toupet fundoplication equally well and durably controlled GORD. Fewer symptoms occurred in those having a semifundoplication, both in the early and late postoperative period.
Coronary angioplasty in high‐risk patients with left main coronary stenosis: Results from the national registry of elective supported angioplasty
Authors: Tommaso Carl L. , Vogel John H. K. , Vogel Robert A. ,   National Registry of Elective Supported Angioplasty
Published: March 2007

AbstractTo assess the outcome of PTCA in circulatory supported patients with left main coronary artery (LMCA) stenosis, the National Registry of Elective Supported Angioplasty data bank was searched. Patients entered in the registry were considered high‐risk PTCA and the PTCA was performed using percutaneous cardiopulmonary bypass (PCPB). Criteria for high risk was left ventricular ejection fraction <25% or a target lesion supplying >50% of functioning myocardium. Of 455 patients entered in the registry, 61 (13.3%) had LMCA stenosis >60%. There were 42 patients in whom the PTCA target vessel was the LMCA (PTCA‐LMCA) and 19 in whom it was vessel(s) other than the LMCA (PTCA‐OTHER). The mean age was similar in the 2 groups (65 ± 10 vs. 68 ± 9yrs, p = ns). The left ventricular ejection fraction (LVEF) was higher in PTCA‐LMCA than in PTCA‐other (38 ± 16% vs. 27 ± 16%, p <0.05). The number of vessels dilated/patient was higher in PTCA‐LMCA than in PTCA‐OTHER (2.1 ± 1.0 vs. 1.1 ± 0.3, p <0.001). There were a total of 10 in‐hospital deaths (16%) in patients with LMCA >60% stenosis. This exceeds the mortality of the patients with <60% LMCA stenosis entered in the registry (4.5%, p <0.001). There were 6 in‐hospital deaths (14%) in PTCA‐LMCA and 4 (21%) in PTCA‐OTHER (p = ns).PTCA in the presence of LMCA stenosis, whether the LMCA is the target vessel or not, carries a very high risk, independent of LVEF or the number of vessels dilated, despite the use of PCPB.