bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality and perforated peptic ulcer: A case for risk stratification in elderly patients
Authors: Irvin T T 
Published: March 2007

Abstract
In a consecutive series of 284 patients with a perforated peptic ulcer (229 pyloroduodenal, 55 gastric) there was a 26 per cent hospital mortality rate, and patients aged ⩾ 70 years (n = 176) had a significantly higher mortality rate (34 per cent) than patients aged &lt;70 years (14 per cent, P &lt; 0·001). Multiple clinical variables were significantly more common in the elderly group of patients (65 per cent), in those having non-steroidal anti-inflammatory drugs or steroid therapy (56 per cent), in patients where there is an absence of a previous dyspeptic history (69 per cent), and when risk factors such as delayed presentation (33 per cent) and the presence of shock on admission to hospital (27 per cent) are present. Definitive operations (vagotomy or gastrectomy) had an increased mortality rate in the elderly (P = 0·018). Risk scores based upon the presence of shock, delayed presentation or concurrent medical illness could have predicted 87 per cent of postoperative deaths in elderly subjects, and it is suggested that risk stratification and greater caution in the use of definitive operations for perforated ulcer may result in a reduction in the high mortality rate in elderly subjects.
Determinants of gastro-oesophageal reflux and their inter-relationships
Authors: Johnsson F , Joelsson B , Gudmundsson K 
Published: March 2007

Abstract
Gastro-oesophageal reflux was measured by 24-h ambulatory oesophageal pH monitoring in 220 patients with symptoms suggestive of gastro-oesophageal reflux disease. By multiple regression analysis it was found that the pressure in the distal oesophageal high pressure zone, the presence of a hiatal hernia, the intra-abdominal length of the high pressure zone, the amplitude of the contraction waves in the distal oesophagus and age all significantly participated in the determination of the amount of gastro-oesophageal reflux. The pressure in the distal oesophageal high pressure zone was the single variable that correlated most strongly to the amount of reflux. Although the amount of reflux increased significantly with increasing weight as measured by Broca's index, this variable did not participate in the determination of reflux by the multiple regression test. The study emphasizes the role of the pressure and intra-abdominal length of the distal oesophageal high pressure zone as the primary antireflux barrier. It also shows that a hiatal hernia plays a role in generating gastro-oesophageal reflux through a mechanism other than affecting the pressure and the intra-abdominal length of the high pressure zone.
Alcohol sclerotherapy of non-parasitic cysts of the liver
Authors: Andersson R , Jeppsson B , Lunderquist A , Bengmark S 
Published: March 2007

Abstract
Between 1980 and 1987, nine patients with non-parasitic cysts of the liver were treated with computed tomography-guided percutaneous puncture and evacuation of the cyst contents followed by injection of absolute alcohol as a sclerosing agent. During the same period only one patient was treated with surgery. The patients included seven women and two men with a mean age of 62 years. Three patients had a single cyst and six patients had multiple cysts. The size of the largest cysts varied between 5 and 20 cm (mean 10 cm). Patients with multiple liver cysts had repeated punctures and sclerosing procedures (up to eight times); 50–3100 ml of cyst fluid (mean 650 ml) was drained per procedure. One patient had symptoms of moderate alcohol intoxication; otherwise no complications were noted. Follow-up was performed with computed tomography or ultrasonography for 8–54 months (median 18 months). The results have been considered successful in eight out of nine patients who had cyst regression and reduced symptons. Two patients, however, required additional surgical treatment due to residual and multiple cysts. Computed tomography-guided alcohol sclerotherapy of non-parasitic liver cysts appears to be a safe and effective initial therapy.
The role of thrombolytic therapy in surgical practice
Authors: Moran K T , Jewell E R , Persson A V 
Published: March 2007

Abstract
The ability of streptokinase and urokinase to lyse intravascular fibrin-based clots is firmly established. However, there is a lack of enthusiasm for these agents because of serious haemorrhagic complications and a lack of controlled randomized studies indicating their efficacy. Thrombolytic therapy is suitable in only 15 per cent of patients with acute deep venous thrombosis. It restores the venous circulation to normal in up to 95 per cent of these patients if therapy is instituted within 5 days of the onset of symptoms. These patients have significantly fewer symptoms on follow-up than patients treated with heparin although the ability of thrombolytic therapy to preserve venous valvular function and to prevent the post-phlebitic syndrome is now in question. Thrombolytic therapy is as effective as heparin in preventing pulmonary embolism and may be superior in its treatment. Pulmonary haemodynamics are rapidly improved, diffusion capacity is restored and, although the evidence is inconclusive, long-term pulmonary hypertension may be prevented. Although the mortality rate is not decreased, controlled studies show that thrombolytic therapy may be beneficial in massive pulmonary embolism with clinical shock. Thrombolytic therapy is indicated for acute arterial and acute bypass graft occlusion when the surgical alternative is associated with a higher morbidity and mortality. Partial thrombolysis is achieved in up to 90 per cent of cases and the need for further therapeutic intervention is eliminated in one-third of the patients treated. New thrombolytic agents with greater specificity and potentially greater efficacy and fewer complications are being developed. Tissue plasminogen activator has been successfully used. Prourokinase, fibrin-seeking urokinase and acetylated streptokinase—plasminogen complex may expand the role of thrombolytic therapy in surgical practice.
Role of B-mode venous mapping in infrainguinal in situ vein—arterial bypasses
Authors: Leopold P W , Shandall A , Kupinkski A M , Chang B B , Kaufman J , Shah D M , Leather R P 
Published: March 2007

Abstract
Two hundred and eighty patients underwent B-mode mapping (B-map) of their saphenous vein over a period of 3 years (1984–1987) before lower limb revascularization. B-map deemed that 229 veins were suitable for bypass, 26 were questionable and 25 were unsuitable. A successful bypass was achieved in 97·8 per cent of the suitable group (all in situ), 85 per cent of the questionable group (in situ and composite vein), and 80 per cent of the unsuitable group (composite vein). At a minimum follow-up period of 1 year the overall patency rate was 95·0 per cent with a revision rate of 15·8 per cent. There was no correlation between revision rate and vein complexity or calf vein diameter. Calf vein diameter &gt; 2·5 mm was correlated with a successful bypass (P &lt; 0·001). It is concluded that B-map is the investigation of choice for saphenous vein assessment before infrainguinal bypass surgery.
Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy
Authors: Nicholson M L , Neoptolemos J P , Sharp J F , Watkin E M , Fossard D P 
Published: March 2007

Abstract
Technetium-99m-labelled red blood cell scintigraphy was used in the investigation of 41 patients with major rectal haemorrhage. Red cells were labelled in vivo with technetium-99m pertechnetate and serial scans (0–36 h) were taken using a large field γ camera. Twenty-two men and 15 women, mean age 71·3 years (range 32–91 years), and four children were studied. Forty-three scans were performed in all and there were 31 positive and 12 negative results. In each case the accuracy of the scan in localizing the bleeding site was checked either by independent investigations or at laparotomy. A definite bleeding site was identified in 30 cases and red cell scintigraphy correctly localized 29 of these (sensitivity 97 per cent). In the remaining 13 cases a bleeding site was not identified by any of the independent investigations and in this group there were two false positive scans (specificity 85 per cent). The investigation had a high predictive value when both positive (94 per cent) and negative (92 per cent). These data suggest that technetium-99m-labelled red cell scintigraphy should be used more widely in the investigation of patients with suspected lower gastrointestinal haemorrhage.
High volume lesser sac lavage in acute necrotizing pancreatitis
Authors: Teerenhovi O , Nordback I , Eskola J 
Published: March 2007

Abstract
The effect of lesser sac drainage with or without lavage on some early predictors and on outcome in acute necrotizing pancreatitis was analysed. The evaluation was made prospectively for 24 patients, in a single centre study. According to Ranson's criteria and laparotomy findings, the lavage and drainage groups were comparable and the pancreatitis was severe and necrotizing in both groups. In a longitudinal analysis of the first 4 postoperative days, lavage did not show any advantage over drainage, as measured by seven prognostic signs (serum creatinine, blood glucose, base excess, haematocrit, white blood cells, C-reactive protein and immunoreactive phospholipase A2 concentration). Furthermore, the study did not find that lavage had any positive effect on the incidence of mortality (36 versus 17 per cent in the drainage group) or on septic complications in acute necrotizing pancreatitis. In the total series the extent of pancreatic necrosis was an essential predictor of the outcome.
Surgical strategy in primary retroperitoneal tumours
Authors: Serio G , Tenchini P , Nifosi F , Lacono C 
Published: March 2007

Abstract
Sixty-nine patients with primary retroperitoneal tumours (17 benign, 52 malignant including 4 malignant tumours of uncertain origin) were reviewed to determine the best form of surgical strategy. Total resection was performed in 88 per cent of benign cases and in 65 per cent of malignant cases. In 62 per cent of the total resections for malignant tumours, en bloc excision included adjacent organs or anatomical structures. Operative mortality rate (in terms of the total number of operations performed) was 5 per cent. Postoperative complications occurred in 14 per cent and recurrences in 35 percent. The overall 5-year survival rate was 67 per cent in patients with totally resected tumours and zero in patients whose tumours were treated by partial resection or biopsy. An aggressive surgical approach aimed at total excision of the tumour is the best form of therapy currently available. In the totally resected retroperitoneal tumour, the use of adjuvant radiotherapy and/or chemotherapy depends on the grade of the malignancy and clearance as assessed histologically. Careful follow-up based on the use of computerized axial tomography and ultrasound allows early identification of recurrence at a stage when the recurrence is amenable to total resection.
Sequelae of internal sphincterotomy for chronic fissure in ano
Authors: Khubchandani I T , Reed J F 
Published: March 2007

Abstract
A total of 1355 patients underwent internal sphincterotomy for chronic fissure in ano between 1980 and 1985. Surgical data were obtained for 1102 patients, and 829 patients responded to a questionnaire. Of the 1057 for whom the time of healing was recorded, 1033 (97.7 per cent) healed by a mean time of 5.6 weeks. No significant differences in satisfaction with the outcome or in deficits in continence were noted between groups undergoing lateral, bilateral or posterior midline sphincterotomy. Excision of the fissure was found to be unnecessary. According to responses on the questionnaires, deficits in continence ranging from ‘sometimes’ to ‘frequently’ included lack of control of flatus (35.1 per cent), soiling of underclothing (22.0 per cent) and accidental bowel movements (5.3 per cent). A significantly higher proportion of patients who had accidental bowel movements were aged over 40 years.
Adjuvant multimodality treatment of rectal cancer
Authors: Galloway D J , Cohen A M , Shank B , Friedman M A 
Published: March 2007

AbstractIt has long been recognized that curative surgery as the sole treatment for rectal cancer yields disappointing results. There is now a growing body of evidence from prospective randomized clinical trials to support the role of adjuvant therapy for patients whose primary tumour has spread through the rectal wall or has associated lymph node involvement. Carefully planned radiation therapy with adequate doses and fields can reduce the risk of locoregional failure. Chemotherapeutic agents delivered either systemically or regionally may also contribute to better disease control and survival. A number of diagnostic and therapeutic issues still need to be addressed in order to use the available adjuvant treatment methods most appropriately. Efforts to refine patient selection, to enhance therapeutic effect and to minimize toxicity are likely to improve the outlook for patients with resectable rectal cancer.
Mesoatrial shunt: A surgical option in the management of the Budd–Chiari syndrome
Authors: Stringer M D , Howard E R , Green D W , Karani J , Gimson A S , Williams R 
Published: March 2007

Abstract
The Budd-Chiari syndrome, arising from hepatic venous outflow obstruction, is frequently complicated by inferior vena caval occlusion or obstruction. Satisfactory decompression of the liver by either portacaval or mesocaval shunts may therefore prove impossible or be prone to failure from shunt thrombosis. The mesoatrial shunt which allows the portal vein to drain directly into the right atrium has previously been advocated in this situation. Five patients with the Budd-Chiari syndrome and caval occlusion and/or obstruction have had mesoatrial shunts constructed using externally supported polytetrafluoroethylene grafts. A single thoracoabdominal incision, incorporating a median sternotomy, was found to provide a satisfactory approach. All patients recovered well with resolution of ascites, diminution in liver size and improvement in inferior vena caval pressure gradients. Furthermore, all shunts have remained patent, as determined by Dopper flow studies and contrast-enhanced computed tomographic scanning, during follow-up periods ranging from 9 to 16 months. If these results are supported by longer term studies, the mesoatrial shunt may become the surgical treatment of choice in patients with hepatic vein occlusion and the Budd-Chiari syndrome associated with inferior vena caval obstruction.
General practice-based population screening for abdominal aortic aneurysms: A pilot study
Authors: O'Kelly T J , Heather B P 
Published: March 2007

Abstract
All 1195 male patients aged between 65 and 74 years on the Family Practitioner Committee register for the four group practices in Stroud, UK were invited for a health screening check. The examinations included abdominal ultrasonography to measure maximum aortic diameter, measurement of blood pressure and recording of smoking habits. An attendance rate of 76 per cent was achieved (906 patients). Seventy-one patients (7.8 per cent) were found to have aortic diameters &gt; 2-5 cm and 14 (1.5 per cent) had aortic diameters &gt; 4.0 cm. Aneurysms were more common in smokers and in hypertensive patients. However, restriction of screening to patients with these risk factors would have led to a number of aneurysms remaining undiscovered. We recommend therefore that ultrasound screening for abdominal aortic aneurysms should be offered to all men between the ages of 65 and 74 years.
Clinical and histological sequelae of Roux-en-Y diversion
Authors: Hollands M J , Filipe I , Edwards S , Brame K , Maisey M , Owen W J 
Published: March 2007

Abstract
Nine post-Polya gastrectomy patients with symptoms of reflux gastritis were studied immediately before and 6 months after Roux-en-Y diversion with a 60 cm jejunal loop. Endoscopy, histology, HIDA radionuclide studies and add secretory studies were performed to determine the effect of Roux-en-Y diversion. Symptomatic results were pleasing in that all patients were graded as Visick I or II. There was a statistically significant improvement in endoscopic evidence of mucosal damage (median score of 6 reduced to median ofl) and visible bile reflux (median score of 10.5 reduced to 0). Foveolar hyperplasia, superficial chronic gastritis and histological precursors of malignancy all improved. There was a significant decrease in the reflux of 99mTc-labelled HIDA into the gastric remnant while acid secretion remained unchanged. Roux-en-Y diversion with a 60 cm jejunal loop provides not only symptomatic relief but scintiyraphic, endoscopic and histological evidence of pancreatobiliary diversion.
Gastric banding in the treatment of morbid obesity
Authors: Kirby R M , Ismail T , Crowson M , Baddeley R M 
Published: March 2007

Abstract
Gastric banding was carried out in 30 patients as a treatment for morbid obesity. The mean excess weight lost at 3 months was 32.6 per cent (27 patients) and 69.7percent at 2 years (eight patients). Fifteen patients required 22 reoperations for technical complications. Two patients underwent removal of the band and seven patients were converted to a stapled vertical Silastic® ring gastroplasty. Although gastric banding appears to be a satisfactory method of achieving weight loss, the complication and reoperation rates are unacceptable in our hands. It is recommended that this operation should no longer be used as a treatment for morbid obesity.
Yersinia infections in surgical practice
Authors: Attwood S E A , Cafferkey M T , Keane F B V 
Published: March 2007

Abstract
This article reviews the clinical manifestations of Yersinia bacteria emphasizing their recent rise in incidence and describing how Yersinia infection presents to the general surgeon. Geographical variations, patterns of disease, pathogenicity and the problems in diagnosis and management are discussed. This common but often unrecognized infection is usually self-limiting but the very young, the very old and the immunocompromised are at greater risk and prompt treatment is required to save lives.
Incidence of septic and thromboembolic-related deaths after splenectomy in adults
Authors: Pimpl W , Dapunt O , Kaindl H , Thalhamer J 
Published: March 2007

Abstract
In a review of 37012 autopsies over the last 20 years 202 deceased adults who had had a splenectomy were investigated. The incidence of infections and thromboembolic complications related to death in these patients was compared with that of a matched deceased population (n = 403) who had not undergone splenectomy. Death-related pneumonia was diagnosed frequently in the splenectomy group and to a lesser extent in the control group (57.9 versus 24.7 percent, P &lt; 0.001). Lethal sepsis with multiple organ failure occurred in 6.9 per cent of the splenectomy group and in 1.5 per cent of the controls (P &lt; 0.001). Purulent pyelonephritis was observed in 7.9 per cent of the splenectomy group and was significantly more frequent than in the control group with its rate of 2.2 per cent (P &lt; 0.001). Finally, pulmonary embolism was the major or a contributory cause of death more often in the splenectomy group than in the control group (35.6 versus 9.7 per cent, P &lt; 0.001). We conclude that splenectomy generates a considerable life-long risk of severe infection and of thromboembolism.
Controlled trial of heater probe treatment in bleeding peptic ulcers
Authors: Fullarton G M , Birnie G G , MacDonald A , Murray W R 
Published: March 2007

Abstract
A prospective randomized controlled trial of endoscopic heater probe therapy in bleeding peptic ulcers was performed to determine whether probe therapy can reduce rebleeding rates. Of 630 patients endoscoped for suspected upper gastrointestinal haemorrhage over a 16-month period, 166 (26 per cent) were found to have a peptic ulcer. Either minor or no stigmata of recent haemorrhage were found in 115 patients at the time of endoscopy. A single peptic ulcer with either active haemorrhage or a visible vessel was found in 51 patients, 43 of whom were entered into the trial. There were eight exclusions: four were inaccessible, one was a torrential haemorrhage and three were excluded for non-technical reasons. Patients were randomized to receive either heater probe (n = 20) or sham (n = 23) therapy. In actively bleeding ulcers, immediate haemostasis was achieved following probe therapy in 14 of 18 patients (78 per cent) compared with none of 21 having sham treatment (P &lt; 0·002). No rebleeding occurred in the probe therapy group (n = 20) compared with rebleeding in five of 23 sham treated patients (P = 0·05). Urgent surgery for haemostasis was required in three of the five sham treated patients who rebled. It is concluded that heater probe therapy may be effective in reducing rebleeding rates in peptic ulcers accessible to the endoscope.
Vascularization of small liver metastases
Authors: Archer S G , Gray B N 
Published: March 2007

Abstract
The portal vein contributes little to the blood supply of established liver metastases in the presence of a patent hepatic artery. However, its role in the perfusion of early metastatic liver disease remains controversial. We have quantified the relative contribution of the portal vein and hepatic artery to the internal circulation of small liver tumours. These studies were conducted in a new rat model of liver metastases generated by the intraportal injection of cultured tumour spheroids. A total of 633 lesions were studied in 18 animals using radioisotope tracer microspheres. Nodules ranged from 0·5 to 6·0 mm in diameter, 92 per cent being 3·0 mm or less. The ratio of radioactivity in tumour compared with normal tissue (T:N ratio) was determined after simultaneously injecting microspheres into the portal and arterial circulation of each animal. The mean hepatic artery T:N ratio was significantly greater than that of the portal vein for all tumour sizes studied (P &lt; 0·01). Nodules 0·5 mm in diameter had a mean (s.e.m.) hepatic artery T:N ratio of 1·50 (0·12) in comparison with a mean portal vein ratio of 0·13 (0·04). Tumour nodules 2·0 mm in diameter had a mean (s.e.m.) hepatic artery T:N ratio of 1·26 (0·11) in comparison with a mean portal vein ratio of 0·06 (0·01). The overall T:N ratio for both routes decreased with increasing tumour size. These results indicate that hepatic tumours as small as 0·5 mm already have an established internal vasculature perfused predominantly by the hepatic artery. In contrast, the portal vein contributes insignificantly to the internal perfusion of these lesions. These results have significant implications for adjuvant locoregional therapy in gastrointestinal cancer.