bluuebunny/crossref_metadata_2025_split huggingface dataset:
General surgery with a special interest in vascular surgery: Changing patterns of workload
Authors: Whiteley M S , Ray-Chaudhuri S B , Cornes J , Michaels J A , Galland R B 
Published: March 2007

Abstract
Prospective surveys of workload were carried out during 1989, 1990 and 1995. Analysis of outpatient referrals, inpatients and operations performed over periods of 3 months was undertaken and the changing patterns of general surgical and vascular surgical workload noted. The number of outpatient referrals rose throughout the study period because of a significant increase in the number of patients with both varicose veins and other vascular problems. There was an increase in the number of emergency admissions for vascular disease. The number of patients having general surgical operations fell; there was a corresponding increase in the number for arterial and venous disease. The general surgical component of a general surgical unit with a vascular interest is gradually declining, as increased numbers of patients with vascular problems are being referred and managed.
Changing patterns in aortoiliac reconstruction: A 7-year audit
Authors: Whiteley M S , Ray-Chaudhuri S B , Galland R B 
Published: March 2007

Abstract
A prospective vascular audit was performed in this hospital between 1988 and 1994. There was a substantial increase in the number of vascular reconstructions (78 in 1988; 141 in 1994). Aortobifemoral grafts for occlusive disease comprised 18 per cent of the operations in 1988 and 0·7 per cent in 1994 (95 per cent confidence interval 0·086–0·259). There was a corresponding increase in the number of extra-anatomic grafts (from 3 to 20·6 per cent). There was a threefold increase in the number of percutaneous angioplasties performed for iliac occlusive lesions (14 in 1988; 41 plus 13 iliac stent procedures in 1994). This had no impact on the total rate of surgical intervention for aortoiliac disease, although it probably aided the shift to extra-anatomic reconstruction by dilatation of the donor side. To investigate whether this change is national, rather than local, graft sales figures were obtained from two vascular graft companies; these confirmed a national trend away from aortobifemoral grafting and provide some evidence to support an increase in extra-anatomic bypass grafting.
Prospective study of carotid endarterectomy and contralateral carotid occlusion
Authors: Da Silva A F , McCollum P , Szymanska T , De Cossart L 
Published: March 2007

Abstract
A total of 700 patients who had carotid endarterectomy (CEA) in the UK and Ireland during a 6-month interval between March and August 1994 were studied prospectively. Some 108 patients (15·4 per cent) had a contralateral internal carotid artery occlusion. Previous reports have shown an associated stroke rate of about 10 per cent in these patients. This study assessed complications and outcome for patients undergoing CEA with contralateral internal carotid artery occlusion compared with those without. The indications for surgery were comparable between the two groups although the patients with occlusion had a slightly higher incidence of arrhythmia and stroke. Intraoperative shunts were used in a significantly higher proportion of those with occlusion (83·3 versus 64·7 per cent, P = 0·0001). The combined death and stroke rate for patients with occlusion was 5·6 per cent compared with 2·4 per cent for the remainder (P not significant). On the basis of the present data, CEA with a contralateral carotid artery occlusion carries only a slight increase in the rate of postoperative stroke and death. This increase was not statistically significant and is lower than that reported previously.
Management cost of acute limb ischaemia
Authors: Braithwaite B D , Jones L , Heather B P , Birch P A , Earnshaw J J 
Published: March 2007

Abstract
The cost of attempting limb salvage in patients who presented with acute lower limb ischaemia was recorded prospectively for 20 months. Seventy-five patients were admitted during the study; 45 were treated primarily by radiological intervention and 18 had primary surgery. The remainder were treated conservatively. Patients who had primary surgery required fewer visits to the operating theatre than those who had primary thrombolysis, but there was no difference in the total time that the theatre or radiology suite was occupied: median 2·3 (10th centile range 1·5–5·0) h and 3·0 (2·0–5·0) h respectively. Median (range) cost of disposables for performing surgery was £82 (58–169) and for thrombolysis was £407 (252–596). When the costs of using the theatre or radiology suite were included, the costs of both treatments were similar: surgery £683 (309–1438) and lysis £861 (611–1244). Median (10th centile range) inpatient stay for surgical patients was 9 (3–18) days and for those having thrombolysis 11 (2–29) days. Median (10th centile range) costs for bed occupancy were similar in both groups: surgery £2497 (643–9115) and lysis £2189 (902–6020). Mean cost for attempting limb salvage by surgery was £3429 (1094–10 065) compared with £3230 (1543–8353) for thrombolysis.
Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano
Authors: Beckingham I J , Spencer J A , Ward J , Dyke G W , Adams C , Ambrose N S 
Published: March 2007

Abstract
Forty-two patients with a suspected diagnosis of fistula in ano underwent prospective comparison of digital rectal examination, dynamic contrast enhanced magnetic resonance imaging (DCEMRI) and surgical exploration. There were five discordancies: DCEMRI showed an ischiorectal abscess and track with no enteric connection in one patient who at operation was found to have a well epithelialized primary fistula. Four patients with fistulas on DCEMRI had no enteric opening found at surgery and were treated as having sinuses. Long-term follow-up has shown failure to heal in all patients and further surgery confirmed missed fistula. Compared with final outcome measures DCEMRI had a sensitivity of 97 per cent and specificity of 100 per cent in the detection of fistula. DCEMRI also identified more secondary tracks and was more accurate at identifying complex fistulas than either digital rectal examination alone or surgical exploration.
Oesophagogastrectomy for iatrogenic perforation of oesophageal and cardia carcinoma
Authors: Adam D J , Thompson A M , Walker W S , Cameron E W J 
Published: March 2007

Abstract
A casenote review identified 18 patients with carcinoma of the oesophagus and gastric cardia who underwent transthoracic oesophagectomy after instrumental perforation. Oesophagectomy was performed within 48 h in ten patients (early surgery group) and after a median delay of 22 (range 5–48) days in eight patients (delayed surgery group). All patients underwent resection via left thoracolaparotomy with immediate intrathoracic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurred in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate intrathoracic anastomosis can be performed without anastomotic leakage but there is high associated respiratory morbidity. The timing of oesophagectomy has little effect on hospital morbidity or mortality rates but early surgery is associated with better long-term survival.
Cardiac complications after hepatic resection
Authors: Yanaga K , Takenaka K , Yamamoto K , Nishizaki T , Shirabe K , Shimada M , Kawahara N , Chishaki A , Sugimachi K 
Published: March 2007

Abstract
During a period of 94 months between 1985 and 1993, 474 hepatic resections were performed in 451 patients, of whom 23 (5 per cent) had cardiac problems: ischaemic heart disease in 16 (previous myocardial infarction in five and angina pectoris in 11), arrhythmic disorders in three, valvular disease in three (previous mitral valve replacement in two) and hypertrophic cardiomyopathy in one. The cardiac patients had a higher incidence of cardiac complications (24 versus 0 per cent, P&lt; 0·0001) including two myocardial infarctions, and of non-cardiac complications consisting of postoperative liver failure (16 versus 4 per cent, P&lt;0·01) and bile leak (16 versus 5 per cent, P = 0·02), as well as hospital death (16 versus 3 per cent, P&lt; 0·001). However, long-term survival was similar in the two groups. Patients with preoperative cardiac conditions appear to be at increased risk for early postoperative morbidity and mortality after hepatic resection.
Pilonidal sinus: Experience with the Karydakis flap
Authors: Kitchen P R B 
Published: March 2007

Abstract
A personal series of 141 patients with postanal pilonidal sinus was treated by the Karydakis operation. Each sinus was totally excised with a vertical eccentric elliptical excision. A thick flap was created by undercutting the medial edge and advancing it across the midline so that the whole suture line was lateralized to reduce the risk of recurrence. Follow-up was achieved in 114 patients for 1–108 months; 79 (69 per cent) were followed for more than 18 months. Overall there were five recurrences (4 per cent) which required further surgery. Thirty-three patients (23 per cent) were referred following recurrence or failure of healing after previous surgery elsewhere; all were cured by this method. The Karydakis operation has a low recurrence rate because it produces a shallow midline furrow free from scar or suture holes which is less vulnerable to hair penetration than a midline wound.
Selective approach to the treatment of oesophageal cancer
Authors: Junginger T , Dutkowski P 
Published: March 2007

Abstract
Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1–3 pN0–1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0·01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two- field lymph node dissection for patients with limited tumours (pT1–3 pN0–1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).
Laparoscopic ultrasonography during cholecystectomy
Authors: Röthlin M A , Schöb O , Schlumpf R , Largiadèr F 
Published: March 2007

Abstract
The routine use of intraoperative cholangiography during cholecystectomy has been debated extensively. Intraoperative ultrasonography was a quick, efficient alternative in open cholecystectomy. A prospective controlled trial to evaluate its usefulness in laparoscopic cholecystectomy is reported. Two groups of 100 patients each were examined during operation with laparoscopic ultrasonography and intraoperative cholangiography. In the first group an adapted urethral probe was used and in the second group a new specialized laparoscopic probe. Intraoperative cholangiography followed immediately after laparoscopic ultrasonography in each patient. In group 1 bile duct stones (n = 4) were detected with a sensitivity of 100 and 75 per cent, a specificity of 98 and 99 per cent, and an overall accuracy of 98 per cent for both ultrasonography and cholangiography. In group 2, 11 patients demonstrated common duct calculi. The sensitivity, specificity and overall accuracy for laparoscopic ultrasonography and intraoperative cholangiography were 91 and 64 per cent, 100 and 100 per cent, and 99 and 96 per cent respectively. The differences between groups 1 and 2 and between ultrasonography and cholangiography were not significant. Variations in the anatomy of the bile duct were observed in 21 patients in group 1 by laparoscopic ultrasonography and in 20 by intraoperative cholangiography. In group 2, 64 variations were demonstrated in 50 individuals by ultrasonography and 61 variations in 47 patients by cholangiography. Vascular variations were seen with ultrasonography in 22 and 24 patients in groups 1 and 2 respectively. In conclusion, laparoscopic ultrasonography (with either probe) proved as accurate as intraoperative cholangiography in detecting bile duct stones, and the specialized probe detected significantly more variations of the bile duct than the adapted probe.
A Western surgical experience of peripheral cholangiocarcinoma
Authors: Berdah S V , Delpero J R , Garcia S , Hardwigsen J , Le Treut Y P 
Published: March 2007

Abstract
The aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1-, 2- and 5-year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tumours.
Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions
Authors: Tingstedt B , Isaksson J , Andersson R 
Published: March 2007

Abstract

Background
This study examined the natural course of patients following surgery for small bowel obstruction (SBO) caused by abdominal adhesions. In addition, a cost analysis was performed.

Methods
A retrospective analysis was undertaken of 102 patients who underwent surgery between 1987 and 1992 for intestinal obstruction due to abdominal adhesions.

Results
Median follow-up was 14 years. The 102 patients experienced 273 episodes of intestinal obstruction after the index operation, of which 237 involved inpatient readmissions; 47·3 per cent of the episodes resulted in further surgery. Single band adhesions were more common in patients with no previous abdominal surgery (P &lt; 0·001). Some 52·0 per cent of the patients had undergone only one operation for SBO. A mean of 2·7 episodes per patient occurred after the index operation. The cost of adhesion-related problems in this study was €1 588 594 or €6702 per inpatient episode.

Conclusion
The readmission rate in a selected cohort of patients with proven intra-abdominal adhesions was higher than reported previously. The annual cost of adhesion-related problems in Sweden was estimated as €39·9–59·5 million, and the cost of inpatient readmissions was almost equal to that for gastric cancer.
Early introduction of laparoscopic sigmoid colectomy during residency
Authors: Daetwiler S , Guller U , Schob O , Adamina M 
Published: March 2007

Abstract

Background
Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency.

Methods
From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed.

Results
A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P &lt; 0·001) intraoperative blood loss (200 versus 100 ml, P &lt; 0·001) and conversion rate (13·6 versus 2·1 per cent, P = 0·002) all decreased with increasing surgical experience (trainee versus trainer).

Conclusion
It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.
Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study
Authors: Naidoo D. , Boon J.M. , Mieny C.J. , Becker P.J. , van Schoor A.‐N. 
Published: March 2007

AbstractThe external branch of the superior laryngeal nerve (ELN) is intimately associated with the superior thyroid artery (STA) in relation to the superior pole of the thyroid gland, rendering it vulnerable to injury during the ligation of this vessel during thyroidectomy. Although most texts acknowledge the fact that the nerve is in close relation to the STA, there has not been an anatomical study to relate the position of the ELN to the superior pole of the thyroid gland. The aim of this study was to determine the shortest distance, from the most superior point of the thyroid gland, to the ELN. Bilateral micro‐dissection on 43 adult cadavers, excluding those with thyroid pathology and previous thyroidectomies, was undertaken. The most superior point of the superior pole of the thyroid gland was identified and the shortest distance to the ELN was measured with a digital calliper (accuracy 0.01 mm). The metric study indicated a mean distance from the ELN to the superior pole of a normal sized thyroid gland of 5.76 mm (range: 2.00–11.26) on the right, and 6.17 mm (range: 2.78–13.48) on the left. From the literature, it is clear that the ELN may even be closer to the superior pole of an enlarged thyroid gland. The recommendation to stay on the substance of the superior pole of the thyroid gland when ligating the STA remains valid, as the nerve is extremely close in relation to the superior pole of the normal thyroid gland. Clin. Anat. 20:516–520, 2007. © 2007 Wiley‐Liss, Inc.
The pulmonary venous wedge pressure in pulmonary arterial hypertension
Authors: Waldman J. Deane , Lacorte Michael , Dick Macdonald , John Sarah A. , Miettinen Olli S. , LaFarge C. Grant 
Published: March 2007

AbstractThe comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed during cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations.Fifty‐five pull‐back pressure recordings from branch‐to‐main pulmonary artery were analyzed. Twenty‐four percent (13/55) had systolic pressure gradients >20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectively). In 46 of 48 patients the PVWPm was not significantly greater than the ipsilateral PAP. Twenty‐nine of 30 patients with PVWPm <30 mm Hg. had an ipsilateral PAPm <40 mm Hg. In 15 patients with PVWPm between 30 and 39 mm Hg, there was a wide range (30–59 mm Hg) of PAPm. Three patients with PVWPm >40 mm Hg. had severe PAH.It is concluded that: 1) hemodynamically significant branch‐to‐main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from main PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWPm <30 mm Hg. usually indicates an ipsilateral PAPm <40 mm Hg; 4) a PVWPm >30 mm Hg. is compatible with either moderate or severe PAH; 5) correlation of PVWP with PAP is not related to pulmonary blood flow.
Unsuspected left‐to‐right shunt: Is routine use of hydrogen platinum electrode system indicated in shunt detection?
Authors: Iskandrian Abdulmassih S. , Kimbiris Demetrios , Bemis Charles E. , Carver Joseph 
Published: March 2007

AbstractUnsuspected left‐to‐right shunt was found in 6 of 1,500 adult patients undergoing diagnostic cardiac catheterization.In 3 patients were found unsuspected secundum atrial septal defects (1 associated with mitral stenosis and 2 with coronary artery disease). In 3 patients, unsuspected partial anomalous pulmonary venous drainage was found (1 associated with aortic valve disease and 2 with severe coronary artery disease).It is concluded that the incidence of unsuspected left‐to‐right shunt diagnosed during routine cardiac catheterization is very low. Careful physical examination and the application of conventional techniques during cardiac catheterization should suggest the possibility of such a shunt. Hydrogen platinum electrode system (HPES) should be reserved for patients in whom the right heart catheter takes an abnormal course or when the pulmonary artery oxygen saturation is high and the arteriovenous oxygen difference is small.
Electrocardiographic correlates of ultrasonically increased septal, left ventricular posterior wall and left ventricular internal dimensions
Authors: Browne Patrick J. , Benchimol Alberto , Desser Kenneth B. , Sheasby Connie 
Published: March 2007

AbstractThe electrocardiograms (ECG) of 64 subjects who exhibited an echocardiographically demonstrable increase in thickness of the interventricular septum and left ventricular posterior wall (Group 1,22 patients), isolated left ventricular internal dimension (Group 2, 26 patients), combined wall thickness and chamber diameter (Group 3, 2 patients), and septal thickness, (Group 4, asymmetric septal hypertrophy, 14 patients) were reviewed in order to determine sensitivity of ECG criteria for the diagnosis of left ventricular hypertrophy (LVH) proposed in 1949 by Sokolow and Lyon (13), in 1968 by Romhilt and Estes (14), and in 1973 the New York Heart Association (15). Relative sensitivity of the three methods was as follows: Total group, NYHA (77%) > Sokolow and Lyon (67%) > Romhilt and Estes (58%); Group 1, NYHA (91%) > Sokolow and Lyon (73%) > Romhilt and Estes (54%); Group 2, NYHA and Sokolow and Lyon (65%) > Romhilt and Estes (61%); Group 4, NYHA (79%) > Sokolow and Lyon (64%) > Romhilt and Estes (57%). We conclude that (1) ECG criteria of the NYHA for the diagnosis of LVH correlate best with an increase of ultrasonically determined septal, left ventricular posterior wall or left ventricular internal dimensions when compared with voltage criteria of Sokolow and Lyon and the point score system of Romhilt and Estes; and (2) isolated increase of left ventricular internal dimension, in the absence of thickened septum or posterior left ventricular wall, frequently results in ECG criteria compatible with the diagnosis of LVH.