bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vascular plasminogen activator and deep vein thrombosis
Authors: de Cossart Linda , Marcuson R W 
Published: March 2007

Abstract
In attempts to determine the aetiology of deep vein thrombosis (DVT) it has been established that some patients with a history of lower limb DVT have a low level of vascular plasminogen activator (VPA) in their superficial hand veins and this combined with a poor VPA release is thought to predispose to thrombosis (1). Hand veins rarely develop thrombosis and so the level of VPA has been measured quantitatively in the more commonly at risk veins of the lower limb. In 6 limbs operated on for varicose veins, paired samples of vein from the groin and from the calf were examined. The median activity score for the groin veins (8138 cpm/μg) was significantly higher than the activity in the calf veins (2353 cpm/μg) (P = 0·01). In 9 limbs amputated for critical ischaemia, paired samples of calf long saphenous vein and soleal vein were examined. The VPA in the former was 1675 cpm/μg compared with 6796 cpm/μg in the soleal veins. This difference is significant at the 1 per cent level. A correlation has been shown between the VPA content of these two sets of veins (R = 0·87).
The low level of VPA in the superficial calf veins may be an aetiological factor in superficial thrombophlebitis, but the commonest site for DVT, the soleal veins of the calf, have a high level of VPA.
Adjuvant distal arteriovenous shunt with femorotibial bypass for critical ischaemia
Authors: Harris P L , Campbell H 
Published: March 2007

Abstract
In a series of 59 femorotibial bypass operations for critical ischaemia an arteriovenous (A-V) shunt was constructed at the distal anastomosis in 36 patients whose pedal angiograms showed an occlusion in the primary pedal arch. Mean blood flow recorded in the grafts without the shunt in the patients whose primary pedal arch was occluded was 83·6 ± 9·9 ml/min (mean ± s.e.m.) compared with 152·16·2 ml/min in those patients whose primary pedal arch was intact (P&lt;0·01). This increased to 236 ± 20·5 ml/min with the shunt open (P&lt;0·001). Twelve months after operation the cumulative patency rate for grafts with an A-V shunt was 46·5 per cent compared with 40·5 per cent for grafts in the better risk patients with a patent primary pedal arch who did not receive a shunt. No side effects were observed due to the presence of a shunt. The importance of the primary pedal arch and the rationale of adjuvant distal arteriovenous shunt are discussed. The results indicate that the addition of an arteriovenous shunt at the distal anastomosis of a long femorotibial bypass is of benefit when blood flow through the graft is limited by occlusive disease in the pedal arteries.
The role of pancreatico-biliary secretions in intestinal adaptation after resection, and its relationship to plasma enteroglucagon
Authors: Al-Mukhtar M Y T , Sagor G R , Ghatei M A , Bloom S R , Wright N A 
Published: March 2007

Abstract
Two groups, each containing 16 male Wistar rats, had either 75 per cent small bowel resection or jejunal transection; 8 animals from each group had previously been subjected to pancreatico-biliary diversion. All animals were killed 12 days after the operation, plasma enteroglucagon levels were measured and crypt cell production rate (CCPR) at different sites of the remaining small intestine was measured using a metaphase arrest technique with vincristine. In each of the resected groups there was a significant increase in the CCPR and enteroglucagon levels compared with the transected groups. Furthermore it was found that the CCPR and enteroglucagon levels were higher in the resected group without the pancreatico-biliary diversion compared with the resected group with the diversion. This study, although it confirms the importance of pancreatico-biliary secretions in intestinal adaptation, could also indicate that a humoral factor may be important in the control of intestinal cell proliferation. Our findings do not exclude the possibility that enteroglucagon could be a candidate for such a role.
The role of mammography in the evaluation of advanced breast cancer treated by initial endocrine therapy
Authors: Sauven P , Grant R , Burn I 
Published: March 2007

Abstract
Fifty-five patients with locally advanced breast cancer treated with initial endocrine therapy have been followed up for periods of between 6 and 64 months (median 17 months) with regular clinical and radiological examination. The aim of the study was to evaluate the role of mammography in initial assessment, and subsequent follow-up. Fifty patients were available for evaluation and were classified by clinical, and by mammographic data independently. The clinical assessment, using UICC criteria of response, estimated 36 patients (72 per cent) as responders (complete response, partial response and no change). Mammographic assessment of response, using 8 radiological features of malignancy, agreed with the clinical estimate in 48 per cent of cases and 32 patients (64 per cent) were assessed as responders. Where clinical and mammographic assessment differed, it was usually due either to a smaller radiological reduction in tumour size, or mammography demonstrating features of progressive disease not observed clinically. Two other mammographic features studied were of prognostic significance. In 70 per cent of the responders in which microcalcifications were present, they became reduced in number but increased in size, a change not seen in non-responders. A curvilinear band, or ‘rainbow sign’, is described which is an early sign of localized skin infiltration and was associated with a poor prognosis.
Peritoneovenous shunts in the management of malignant ascites
Authors: Souter R G , Tarin D , Kettlewell M G W 
Published: March 2007

Abstract
Peritoneovenous shunts have been inserted into 26 patients to control malignant ascites. All benefitted and most required no further paracentesis until death from progressive malignancy. Shunt blockage, which is the major problem at present, occurred in 8 patients. Five patients suffering from far advanced malignancy died within a month of operation. There was no clinical evidence of enhanced tumour spread or disseminated intravascular coagulation. We do not consider that the procedure is the first line of management, neither has it much to offer the patient with viscous, bloodstained or loculated ascites. We suggest criteria which help to identify the patient most likely to benefit from a peritoneovenous shunt.
A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty—one surgeon's results after 5 years
Authors: Fraser A G , Brunt P W , Matheson N A 
Published: March 2007

Abstract
In a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety-eight per cent of patients were reviewed by two physicians after 20–97 mth (mean 61 mth). Fifty-nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P &lt; 0·05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P &lt; 0·001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P &lt; 0·001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P &lt; 0·001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P &lt; 0·05). HSV gave better results than TVP and was associated with a low recurrence rate (1·5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duodenal ulcer.
Infiltrating lobular carcinoma of the breast: An evaluation of the incidence and consequence of bilateral disease
Authors: Dixon J M , Anderson T J , Page D L , Lee D , Duffy S W , Stewart H J 
Published: March 2007

Abstract
A histological review of 1003 invasive breast carcinomas identified 103 patients with infiltrating lobular carcinoma, for whom clinical and survival data were collected in each case. Six patients had bilateral carcinoma at diagnosis and 14 developed a contralateral carcinoma during the period of follow-up. The major factor predicting patients at risk of developing a contralateral carcinoma was histological type. Analysis of survival data on the patients with bilateral disease showed poor survival in the group with synchronous bilateral disease, but no difference in survival between patients with metachronous bilateral and unilateral disease. This suggests that the development of a metachronous contralateral carcinoma does not necessarily reduce the probability of survival of patients with infiltrating lobular carcinoma.
The influence of disease at the margin of resection on the outcome of Crohn's disease
Authors: Heuman R , Boeryd B , Bolin T , Sjödahl R 
Published: March 2007

Abstract
Sixty-seven patients with Crohn's disease undergoing 81 resections followed by a restorative procedure were reviewed to evaluate the influence of microscopic disease at the margin of resection on the recurrence rate. The average follow-up after resection was 5·6 + 2·8 years. The resectional margins were classified into three groups depending on the microscopic appearance of the most involved margin. Recurrent disease developed in 36 per cent of the resections without microscopic evidence of Crohn's disease, while 38 per cent of the resections with signs of Crohn's disease developed a clinical recurrence. The recurrence rate increased with the follow-up time, but was independent of microscopical disease at the resectional margins. Therefore we recommend restricted resection of macroscopically diseased bowel. Microscopical involvement does not seem to increase the recurrence rate.
Rectosacral suture fixation for complete rectal prolapse in the elderly, the frail and the demented
Authors: Carter A E 
Published: March 2007

Abstract
A simple method of fixing the mobilized rectum to the sacrum by sutures is described to treat complete rectal prolapse. Its use over 12 years in 32 patients (29 women and 3 men), 17 with various forms of dementia, is reported with one recurrence for which a repeat identical procedure was successful.
Prostaglandins and acute pancreatitis—experimental and clinical studies
Authors: Standfield N J , Kakkar V V 
Published: March 2007

Abstract
Acute pancreatitis has a mortality of 10–20 per cent, and in cases of acute haemorrhagic pancreatitis this rises to 80–90 per cent. At present there is no reliable treatment for this condition. Based on the hypothesis that the release locally and systemically of the intracellularly activated pancreatic digestive enzymes is due to cell membrane instability, we have studied the cytoprotective (cell membrane stabilizing) role of prostaglandins in this condition. In the first part of this study, an animal model of acute pancreatitis with a mortality of 100 per cent by 14 days has been established by feeding mice a choline-deficient ethionine supplemented diet. Using this model we have demonstrated improved survival (16 out of 50 survived 14 days or longer) by administering prostaglandin E2 subcutaneously (P &lt; 0·02). We have demonstrated that the improved survival is dose-dependent, in the range 2·5–5·0 mg/kg body weight 8 hourly (P &lt; 0·02) and time-dependent, still being effective if treatment is delayed for 24 h (P &lt; 0·02). Great emphasis has been placed on not commencing treatment until after the induction of acute pancreatitis. In the second part we have used cell membrane marker enzymes to study the cell membrane stabilizing effect of prostaglandin E2 in the human. It has been demonstrated that cell membrane instability occurs. In 12 of 50 episodes treated by prostaglandin E2 infusion, the lysosomal, mitochondrial and cell membranes are stabilized, thus decreasing the release of intracellular enzymes.
Surgery for thyrotoxicosis
Authors: Simms J M , Talbot C H 
Published: March 2007

Abstract
Recent reports have suggested the use of radio-iodine for the treatment of all cases of thyrotoxicosis. This paper evaluates the results of 627 patients undergoing subtotal thyroidectomy with a mean follow-up of 5·8 years. The most common complications were hypothyroidism (26·6 per cent) and recurrent thyrotoxicosis (2·6 per cent). Permanent hypocalcaemia occurred in 8 cases (1·4 per cent) and one patient developed a permanent, though asymptomatic, unilateral cord palsy (0·2 per cent). Ultimately all patients receiving radio-iodine appear to become hypothyroid and there is continued worry about possible thyroid malignancy. Almost 70 per cent of our cases were free of complications and euthyroid and we therefore believe that surgery remains the treatment of choice for thyrotoxicosis. We also discuss the difference in results between Graves disease and toxic multinodular goitre.
Hepatic metastases—a physiological approach to treatment
Authors: Chamberlain M N , Gray B N , Heggie J C P , Chmiel R L , Bennett R C 
Published: March 2007

Abstract
Hepatic metastases derived from primary malignancy of the gastrointestinal tract have a grave prognosis, with median survival rates varying from 3 to 11 months. Surgery for isolated metastases and intrahepatic artery chemotherapy are the most effective treatment options currently available. We have explored the potential use of radioactive microspheres delivered into the liver by the hepatic artery as a form of internally irradiating metastatic liver cancer. Microspheres containing radioactive Yttrium injected into the hepatic artery concentrate in the metastases rather than normal liver parenchyma, due to the fact that the blood supply of metastases is derived preferentially from the hepatic artery. Using a rabbit tumour model, radioactive microspheres delivered into the hepatic artery have been shown to lodge preferentially in tumour tissue. The therapeutic application of this phenomenon is that metastases may receive many times the radiation dose delivered to normal liver parenchyma when radioactive microspheres are delivered into the hepatic artery. This would mean that a mean dose of 30 Gy delivered to normal liver tissue would result in greater than 150 Gy being delivered to tumour tissue. Current results in experiments suggest that this form of treatment may have considerable potential for prolonging survival of patients with hepatic metastases.
A hypothesis of the healing of deep dermal burns and the significance for treatment
Authors: Holmes J D , Muir I F K , Rayner C R W 
Published: March 2007

Abstract
Deep dermal burns heal by a combination of new connective tissue formation (granulation) and epithelialization. In deep dermal wounds, which are unhealed after 14 days of conservative treatment, epithelialization can be enhanced by abrasion either alone or combined with provision of a skin graft. Some 42 burn wounds in 25 patients treated by this method have healed quickly and with good results. This method represents a move away from the current trend of early tangential excision and grafting of burn wounds and raises the possibility of developing a regime with the advantages but not the disadvantages of early tangential excision and grafting.
Does 111indium-platelet deposition predict patency in prosthetic arterial grafts?
Authors: Goldman M , Hall C , Dykes J , Hawker R J , McCollum C N 
Published: March 2007

Abstract
The relationship between the rate of 111In-platelet deposition on vascular grafts and subsequent thrombosis has been examined in patients undergoing femoropopliteal by-pass. Sixty-seven patients undergoing femoropopliteal by-pass using vein, Dacron or PTFE were randomized to aspirin plus dipyridamole (ASA/DPM) or placebo. Autologous 111In-platelets were injected in the second postoperative week and Thrombogenicity Index (TI) calculated as the mean daily rise in the ratio of radioactivity graft/contralateral thigh. Graft patency was assessed to 1 year. Mean (+ s.e.m.) TI at 1 week in 21 grafts that occluded within 12 months was 0·19 ± 0·018 compared with 0·07 ± 0·009 in the 38 that remained patient (P &lt; 0·001). Grafts with a TI less or greater than the median had a 90 per cent or 39 per cent cumulative 1-year patency, respectively (P &lt; 0·001). In the prosthetic grafts ASA/DPM reduced mean TI from 0·17 ± 0·02 to 0·11 ± 0·01 (P &lt; 0·02) and enhanced 1-year patency from 36 to 67 per cent (P &lt; 0·05). Following femoropopliteal by-pass TI related to subsequent graft patency. Radiolabelled platelet deposition therefore provides a guide as to how new materials or antithrombotic drugs may influence clinical graft thrombosis. Platelet inhibition reduced both graft thrombogenicity and subsequent occlusion.
The role of partial denervation of the puborectalis in idiopathic faecal incontinence
Authors: Bartolo D C C , Jarratt J A , Read M G , Donnelly T C , Read N W 
Published: March 2007

Abstract
Recent studies have suggested that patients with idiopathic faecal incontinence have neuropathic damage to the external anal sphincter and pelvic floor musculature, though no direct assessment of puborectalis function has been made in intact man. Obstetric trauma and chronic straining at stool are thought to be possible causes for damage to the puborectalis nerve supply. In this study the motor unit potential duration in the external sphincter and puborectalis was measured by conventional electromyography in incontinent patients and two groups of continent patients who strained at stool. Our results confirm that incontinent patients had significant neuropathic damage to the puborectalis and the external sphincter compared with controls. Patients with the descending perineum syndrome, who were continent, showed partial denervation of the external sphincter and puborectalis, though the degree of abnormality in puborectalis was less than that in incontinent patients. Finally, patients with constipation showed neurogenic abnormalities in the external anal sphincter but not in the puborectalis. The findings suggest that partial denervation of the external sphincter can occur independently of partial denervation of the puborectalis in patients who strain at stool but if severe changes are present in both muscles, the patient is likely to be incontinent.
The assessment of calf pump function by isotope plethysmography
Authors: Whitehead S , Lemenson G , Browse N L 
Published: March 2007

Abstract
A method of measuring the function of the calf muscle pump using in vivo 99Tcm-labelled red cells is described. This new, non-invasive method can provide detailed information about the emptying and refilling of the deep and superficial veins of the calf which may prove to be superior to those methods of assessment currently used in the selection and follow-up of patients for venous surgery.
Surgical management of locally recurrent rectal cancer
Authors: Sagar P M , Pemberton J H 
Published: March 2007

Abstract
The surgical management of locally recurrent rectal cancer may involve major procedures and is not for the faint-hearted. Nevertheless, such treatment is preferable to chemotherapy and radiotherapy; the latter will fail over a period of months during which the patient is likely to experience intractable pain. Radical surgery offers good palliation and a better quality of life. Survival is prolonged by such operations which may be curative in up to one-third of patients. Nevertheless, surgeons must be realistic in their assessment of and discussions with patients.
Molecular genetic basis of colorectal cancer susceptibility
Authors: Cunningham C , Dunlop M G 
Published: March 2007

Abstract
The past decade has seen considerable advances in understanding of the molecular processes involved in the development of colorectal cancer. With an increased awareness of genetic aspects of the disease there have already been significant changes in clinical management. This is exemplified by familial adenomatous polyposis, where identification of mutations in the adenomatous polyposis coli (APC) gene in affected individuals can be used directly to reduce the requirement for clinical screening in at-risk relatives. In other more common but less well defined heritable forms of colorectal cancer, testing to identify individuals for early diagnosis and treatment will soon become routine practice. This review does not set out to discuss all aspects of the molecular genetics of colorectal cancer but concentrates on the roles of the APC gene and the recently discovered DNA mismatch repair genes in colorectal cancer. The identification of these genes and their functional significance in the neoplastic process is discussed, and the relevance of such discoveries to future research and clinical management explored.
Reconstruction of a new inferior vena cava after right atrial disruption during recipient hepatectomy
Authors: Oldhafer K J , Ziemer G , Raygrotzki S , Pichlmayr R 
Published: March 2007

Abstract
Polycystic liver disease is a rare indication for liver transplantation1,2. Recipient hepatectomy appears to be the most challenging part of the surgical procedure3. This is especially true in patients suffering from polycystic liver disease, who may have extremely large livers (up to 15 kg). In these patients hepatectomy and, particularly, dissection of the suprahepatic inferior vena cava (IVC) may be difficult. Management of a disrupted suprahepatic IVC, including a tear of the: right atrium, during hepatectomy for polycystic liver disease is described.
Local recurrence following total mesorectal excision for rectal cancer
Authors: Arbman G , Nilsson E , Hallböök O , Sjödahl R 
Published: March 2007

Abstract
Early results after rectal cancer surgery in a defined population were compared before and after the introduction of total mesorectal excision. In the first period (1984–1986) 211 cases of rectal cancer were diagnosed and in the second (1990–1992) 230. Of these, 134 patients in the first period (group 1) had anterior resection or abdominoperineal excision which was considered curative. In the second period 128 curative anterior resections and abdominoperineal excisions were performed by a limited number of surgeons familiar with total mesorectal excision (group 2). No differences between the groups were found in stage distribution, rate of curative operations, postoperative complications or postoperative mortality. Local recurrence had developed in 19 patients in group 1 and in eight in group 2, 1 year after the end of the study periods (P = 0·03). Local radicality was in doubt in 13 patients in group 1 and in eight in group 2. In the remaining 121 and 120 patients, 13 and four local recurrences respectively were present (P = 0·03). Actuarial analysis showed a significant reduction in local recurrence rate (P = 0·03) and an increase in crude survival (P = 0·03) at 4 years in group 2 compared with group 1. Total mesorectal excision reduces the local recurrence rate after excision of rectal cancer.