bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized trial of modified Bassini versus Shouldice inguinal hernia repair
Authors: Paul A , Troidl H , Williams J I , Rixen D , Langen R 
Published: March 2007

Abstract
Between 1986 and 1992, 265 men of mean age 51 (range 16–75) years with a primary inguinal hernia were randomized to undergo surgery by staff surgeon or surgical resident and further randomized to receive a modified Bassini operation (transversalis fascia not divided but included in the repair) or Shouldice procedure. The follow-up rate was 92·1 per cent with a mean follow-up of 3·3 years. Recurrence developed in 12 of 125 patients with a Bassini procedure and two of 119 after a Shouldice repair (9·6 versus 1·7 per cent, P = 0·006). The recurrence rate was no different for staff surgeons and trainees (5·9 versus 5·6 per cent, P not significant). Multivariate analysis identified the presence of a direct hernia (P = 0·003) as the additional main factor for the development of recurrence.
Blood flow measurement in extremity soft tissue sarcoma with technetium-99m hexamethyl-propyleneamineoxime and single photon emission computed tomography
Authors: Hill S , Heary T , Flower M A , Cronin B , McCready V R , Thomas J M 
Published: March 2007

Abstract
Blood flow measurements were made in 28 patients with soft tissue sarcoma of the extremities to investigate the prognostic significance of tumour vascularity. Four patients with benign tumours also underwent blood flow measurement. Mean and maximum tumour blood flow was calculated from technetium-99m hexamethyl-propyleneamineoxime uptake measured using single photon emission computed tomography (SPECT), tumour volume measured from SPECT transaxial image reconstructions and cardiac output assessed with Doppler ultrasonography. Twenty-seven malignant lesions and one benign tumour showed increased uptake of isotope relative to surrounding tissues. Mean sarcoma blood flow varied between 1 and 33 ml per 100 ml tumour per min, and maximum flow between 5 and 57 ml per 100 ml per min. Fourteen patients developed progressive disease during the first year of follow-up. Eight of 11 patients with a high isotope uptake ratio, eight of 12 with a high mean blood flow and eight of 14 with a high maximum blood flow relative to the respective medians for the series showed disease progression.
Intraoperative assessment of nodal status in the selection of patients with breast cancer for axillary clearance
Authors: Hadjiminas D J , Burke M 
Published: March 2007

Abstract
Axillary node status was assessed by intraoperative contact cytology of four sampled nodes in each of 114 consecutive patients with operable breast cancer treated by wide local excision or mastectomy. At a mean follow-up of 18·7 months, 43 node-positive patients who underwent immediate axillary clearance had two locoregional and six distant recurrences with two deaths; four had arm oedema and one shoulder stiffness. There were no recurrences or arm and shoulder morbidity in 71 node-negative women who had no clearance or radiotherapy. The mean hospital stay was 4·3 days for patients having wide local excision versus 7·2 days for those undergoing excision and axillary clearance (P &lt; 0·001), and 8·9 days for patients receiving a mastectomy versus 9·1 days for those having mastectomy and clearance (P not significant). Selective axillary clearance based on intraoperative contact cytology of four sampled nodes reduces hospital stay in patients treated by wide local excision and may lead to a reduction in arm morbidity without impairing disease control.
Chronic obscure groin pain is commonly caused by enthesopathy: ‘Tennis elbow’ of the groin
Authors: Ashby E C 
Published: March 2007

Abstract
Forty-nine patients with chronic obscure groin pain, bilateral in four, presented to one general surgeon in a 12-month period. Inflammation (‘enthesopathy’) at the pubic insertion of the inguinal ligament was the cause in 30 patients (32 groins). This has not previously been recognized as a cause of chronic groin pain, possibly because the exact site of tenderness can be obscured by the pubic pad of fat. Enthesopathy also occurred in five rectus and one adductor longus tendons (one patient had inflammation in both). Infiltration with long-acting steroid (1 per cent triamcinolone) and local anaesthetic (2 per cent lignocaine) was offered to all patients with localized tenderness of tendon or ligament. A questionnaire survey 3–15 months after injection showed a better outcome after treatment than when injection was declined. Other causes of pain included nerve entrapment (five cases), spinal referred pain (five in four patients) and ureteric stones (two). Inguinal hernia is sometimes coincidental rather than causative of the pain. In three patients the pain had subsided and no diagnosis was made. Simple diagnostic and therapeutic measures may relieve chronic groin pain and spare patients elaborate investigation or unnecessary operation.
Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery
Authors: Santos J C M , Batista J , Sirimarco M T , Guimarães A S , Levy C E 
Published: March 2007

Abstract
A total of 149 patients admitted for elective colorectal surgery were randomly allocated to receive preoperative mechanical bowel preparation (group 1) or no mechanical bowel preparation (group 2). All patients received antimicrobial prophylaxis with cephalothin and metronidazole. The overall incidence of wound infection was 17·4 per cent (24 per cent for group 1, 12 per cent for group 2) and that of dehiscence 7·4 per cent (10 per cent for group 1, 5 per cent for group 2). The incidence of wound infection was significantly higher in group 1 (P&lt;0·05) but that of anastomotic dehiscence did not differ significantly between groups. Mechanical bowel preparation is unnecessary and may be harmful in terms of preventing wound infection and anastomotic dehiscence in patients undergoing elective colorectal surgery.
Experimental colonic healing in relation to timing of 5-fluorouracil therapy
Authors: Weiber S , Graf W , Glimelius B , Jiborn H , Påhlman L , Zederfeldt B 
Published: March 2007

Abstract
In an experimental study resembling clinical use of adjuvant 5-fluorouracil (5-FU) treatment of colorectal carcinoma, 97 male Wistar rats were operated on with a standardized left colonic resection. Treatment was given as a daily intraperitoneal injection. The animals were randomized to one of four groups: early treatment with 5-FU 20 mg/kg or saline 0·1 mol/l from the third day after operation to the day 7 after operation, and delayed treatment with 5-FU 20 mg/kg or saline 0·1 mol/l from the third day after operation to the day before killing. The animals were killed in groups on day 7 or 10 after operation. In the group receiving early 5-FU treatment there was an increased rate of anastomotic complications (seven of 26) compared with none in the control or delayed 5-FU groups. The anastomotic breaking strength in animals having early 5-FU treatment (day 7, median 1·45 (range 0·20–2·95) N; day 10, median 1·80 (range 0·95–3·20) N) was significantly lower than that in controls on both day 7 (median 3·20 (range 2·50–3·80) N) and day 10 (median 3·20 (range 2·20–3·60) N). In the delayed 5-FU treatment group anastomotic breaking strength did not differ from that in controls. Colonic healing was not impaired when intraperitoneal 5-FU treatment was started on day 3 after operation, whereas immediate postoperative administration of 5-FU had a detrimental effect on wound healing.
Delorme operation for rectal prolapse
Authors: Tobin S A , Scott I H K 
Published: March 2007

Abstract
A consecutive series of 49 elderly patients of mean age 73 years with full-thickness rectal prolapse underwent the Delorme operation between 1986 and 1990. A standard technique was used, or supervised, by one surgeon. In this prospective series, 43 patients were reviewed clinically. The Delorme operation abolished rectal prolapse in 32 patients. Half of the 40 with faecal incontinence were rendered continent. Failure was related to previous anorectal surgery and/or psychiatric illness. Of the 11 patients in whom the first procedure failed, four were improved by a second Delorme operation. The Delorme operation is a suitable procedure for elderly and/or medically unfit patients with rectal prolapse. Good results have also been demonstrated for younger patients, suggesting that the operation may have wider application.
Surgical aspects of Behçet's disease
Authors: Bradbury A W , Milne A A , Murie J A 
Published: March 2007

Abstract
Behçet's disease is an uncommon condition that is managed primarily by medical therapy. Nevertheless, the widespread manifestations of the disease mean that surgeons from many different subspecialties may be involved in the care of patients. This is especially so for the treatment of life-threatening complications. For this reason the surgeon needs to consider Behçet's disease in the differential diagnosis of many conditions and to be aware of the general principles underlying the surgical care of affected patients.
Digest
Authors: Frileux P , de Chirurgie Annales 
Published: March 2007

Abstract
The Editors are delighted this month to publish the first digest from Annales de Chirurgie, written by Dr Pascal Frileux of that journal. Dr Frileux has chosen from the sixth, seventh and eighth issues of 1994. A reciprocal digest written by our Editor, Professor John Farndon, appears in the eleventh issue of the French journal published in December.
Multi-agent therapy in the treatment of sepsis-induced microvascular injury
Authors: Carey P D , Windsor A C J , Walsh C J , Fowler A A , Sugerman H J 
Published: March 2007

Abstract
Cyclo-oxygenase inhibition (with ibuprofen) combined with histamine (H1, H2) receptor antagonism (with diphenhydramine and cimetidine) attenuates microvascular leak injury in sepsis syndromes. Ibuprofen reduces microvascular injury by limiting oxygen radical production by neutrophils. Histamine is known to inhibit this oxygen radical production, an effect antagonized by cimetidine. In the present study neutrophils isolated from pigs made septic with Pseudomonas organisms exhibited a significant (P &lt; 0.05) increase in the production of the oxygen radicals, superoxide anion (O-2, 133 per cent) and hypochlorous acid (HOCl, 38 per cent). Ibuprofen used alone attenuated this sepsis-stimulated overproduction. Addition of the antihistamines cimetidine and diphenhydramine produced a significant increase in oxygen radical production (P &lt; 0.05), by 122 per cent (O2−) and 47 per cent (HOCl), equivalent to that in untreated septic animals. This coincided with a significant deterioration in pulmonary compliance (P &lt; 0.05) compared with that found in control animals and those treated with ibuprofen alone, and a significant accumulation of extravascular lung water (P &lt; 0.05) at 240 and 300 min versus baseline. Histamine receptor antagonism may inadvertently enhance microvascular injury in sepsis.
Bacterial translocation during peroperative colonic lavage of the obstructed rat colon
Authors: Horgan A F , Stuart R C , O'shaughnessy E M , Cryan B , Kirwan W O 
Published: March 2007

Abstract
Peroperative antegrade colonic lavage is often performed before primary anastomosis in emergency colonic surgery. The influence of colonic lavage on bacterial translocation from the obstructed colon was determined. Forty female Wistar rats were studied in four groups: (1) control; (2) non-obstructed with lavage; (3) obstructed; and (4) obstructed with lavage. Ligature obstruction of the rectum was performed in groups 3 and 4. Some 4 days later 35S-radiolabelled Escherichia coli was inoculated into the colon of all animals. Groups 2 and 4 underwent colonic lavage. Lavage in the group 4 animals with left-sided colonic obstruction significantly increased the levels of E. coli in regional nodes, liver, spleen, lung, kidney and blood (as assessed by organ culture and scintillation counting) compared with those in groups 1, 2 and 3 (P &lt; 0.05). These results suggest that peroperative lavage of the obstructed colon significantly increases the level of bacterial translocation.
Juvenile polyposis
Authors: Desai D C , Neale K F , Talbot I C , Hodgson S V , Phillips R K S 
Published: March 2007

Abstract
Juvenile polyposis is an uncommon condition characterized by the development of multiple juvenile polyps, predominantly in the colon but also in the rest of the gastrointestinal tract. The condition usually presents in childhood; only 15 per cent of patients present as adults. The rarer and often fatal form, namely, juvenile polyposis of infancy, is typified by diarrhoea, protein-losing enteropathy, bleeding and rectal prolapse. The more common form of juvenile polyposis (affecting the colon, stomach and small bowel) occurs in the first or second decade with rectal bleeding and anaemia. A family history of the condition is found in 20–50 per cent of patients with apparently an autosomal dominant trait. The gene for juvenile polyposis has not yet been identified. Epithelial dysplasia is common and the cumulative risk of colorectal cancer is &gt; 50 per cent. Various extracolonic abnormalities may also occur. Most patients are treated surgically for colonic polyps, although endoscopic polypectomy is also an option. The rest of the gastrointestinal tract should be screened as should asymptomatic first-degree relatives.
Influence of temporary faecal diversion on long-term survival after curative surgery for colorectal cancer
Authors: Meleagros L , Varty P P , Delrio P , Boulos P B 
Published: March 2007

Abstract
Experimental carcinogenesis is enhanced at colorectal anastomoses, inhibited by proximal faecal diversion and promoted by the closure of a defunctioning stoma. The clinical relevance of these observations was investigated in a retrospective study of curative restorative resection for colorectal carcinoma. The 5-year disease-free survival rate (95 per cent confidence interval) in 122 patients with a temporary stoma (50·4 (41·1–59·7) per cent) was significantly reduced (P &lt;0·01) compared with that in 218 with no stoma (66·8 (59·4–73·5) per cent). In patients with Dukes B tumours early stoma closure (within 3 months of resection) was associated with a worse survival (P &lt; 0·005) and a higher tumour recurrence rate (P &lt;0·05) than in those with no stoma. Survival rates after late stoma closure were no different from those in patients with no stoma. Multivariate analysis revealed Dukes stage (P &lt;0·0001), tumour differentiation (P = 0·02) and tuning of stoma closure (P = 0·02) as independent predictors of survival. In curative surgery for colorectal cancer temporary faecal diversion confers a survival disadvantage that can be prevented by delayed closure of the stoma.
Restoration of intestinal continuity following Hartmann's procedure: The Lothian experience 1987–1992
Authors: Wigmore S J , Duthie G S , Young I E , Spalding E M , Rainey J B 
Published: March 2007

Abstract
Restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity (anastomotic leak rates 4–16 per cent) and mortality (0–4 per cent) rates. A total of 178 patients, under the care of seven different surgical units, underwent reversal of Hartmann's procedure during a 5-year period, representing the largest series yet reported. The mortality rate of the study group was 0·6 per cent, the anastomotic leak rate was 3·9 per cent and the incidence of anastomotic stricture was 6·7 per cent. The median time interval between resection and reversal was 92 days and no relation was found between timing and complications. Anastomotic stricture occurred significantly more commonly in stapled than in sutured anastomoses (P &lt;0·05); however, leaks were equally common in both types. The mean age of the patients who developed major complications was not statistically different from that of the rest of the study group and there was no difference in premorbid state. The authors believe that the low complication rates reported in this series may be attributable to the high level of operator experience in performing this technically difficult procedure, which was done by a consultant in 66 per cent of cases and by a senior registrar in 33 per cent.
Fate of the non-operated carotid artery after contralateral endarterectomy
Authors: Naylor A R , John T , Howlett J , Gillespie I , Allan P , Ruckley C V 
Published: March 2007

Abstract
The long-term fate of the non-operated internal carotid artery (ICA) in 219 patients undergoing contralateral carotid endarterectomy was studied; 151 patients underwent serial postoperative imaging of the vessel. Cumulative freedom from stroke in the non-operated hemisphere was 99, 96 and 86 per cent at 1, 5 and 10 years respectively, giving a mean incidence of stroke of 1 per cent per annum. Only one stroke was preceded by a transient ischaemic attack and no stroke was associated with severe (70 percent or greater) stenosis of the ICA. Ten patients (7 per cent) with initially mild or moderate disease of the non-operated ICA progressed to severe stenosis during follow-up, but only three became symptomatic and, in each case, the onset of symptoms preceded recognition of disease progression. The long-term risk of stroke in the non-operated ICA territory is very small. Of practical importance is that none of the observed strokes could have been prevented by postoperative surveillance of this type.
Effect of ‘antiembolism’ compression hosiery on leg blood volume
Authors: Sparrow R A , Hardy J G , Fentem P H 
Published: March 2007

Abstract
Blood volume in the legs of healthy volunteers and the ability of graduated compression hosiery to reduce that volume were investigated with γ scintigraphy. Changing posture from supine to upright, or pneumatic thigh cuffs inflated to either 20 or 40 mmHg with the subject supine, significantly increased leg blood volumes; the mean increase was: upright 126 ml, 20 mmHg cuff 44 ml, and 40 mmHg cuff 113 ml. A significant trend in reducing these volumes was noted in three brands of commercially available stockings, with the subject supine and without thigh cuffs (Page's L trend 132·5, P &lt;0·01) and when cuffs were applied at 20 mmHg (Page's L trend 128, P = 0·05). Few of the commercially available stockings delivered the ‘standard’ compression profile of 18 mmHg at the ankle, 14 mmHg at the calf and 8 mmHg at the upper thigh. The effects of other compression profiles were assessed, using custom-made stockings, and pneumatic cuffs inflated to 20 mmHg applied to the upper thighs to impede venous return. There was no consistent reduction of blood volume in the popliteal region, although decreases were seen in the upper and lower calf. The major determinant of performance was compression at the calf; the ankle to calf compression gradient was not important. Stockings with a profile of 16·8 mmHg at the ankle, 14·5 mmHg at the calf and 64 mmHg at the upper thigh performed best.
Effect of high-lipid high-nitrogen intravenous nutrition on total body nitrogen, visceral protein synthesis and nitrogen balance
Authors: Kohlhardt S R , Smith R C , Rose A , Allen B 
Published: March 2007

Abstract
The impact of high-lipid intravenous nutrition (IVN) on selected indices of nitrogen retention following major surgical resection was studied. Twenty-two patients, randomly allocated to two equal well matched groups, received either high-lipid IVN (75 per cent non-protein calories supplied as lipid) or isocaloric isonitrogenous glucose IVN (100 per cent non-protein calories supplied as glucose). Total body nitrogen (assessed by in vivo neutron activation analysis), nitrogen balance and levels of circulating proteins were measured. Mean(s. d.) total body nitrogen and fat-free mass decreased (P = 0·04) in patients receiving high-lipid IVN, −109(36) gN and −1·7(0·4) kg respectively, but not in those given glucose-only IVN, 8(43) gN and 01(1·0) kg. This small loss of body protein does not appear to be clinically significant because postoperative hospital stay, complication rates and the acute-phase protein response (immunological and visceral) were similar in the two groups.
Ceiling-mounted radiographic equipment for trauma management in the emergency room
Authors: Bhagat K K , Earlam R J , Hately W , McAvinchey R , Brown I W , Blakeney C G 
Published: March 2007

Abstract
Use of ceiling-mounted radiographic equipment in an emergency room for management of the multiply injured patient is described. The protocol of the Advanced Trauma and Life Support manual is followed and three plain radiographs (lateral cervical spine, anteroposterior views of the chest and pelvis) are obtained by the radiographers, who are members of the trauma team. Abnormalities were diagnosed on 7 per cent of the cervical radiographs, 31 per cent of the chest and 28 per cent of the pelvis in 108 patients during the first year of use. With full integration of the radiographers into the trauma team these three initial films are obtained within 10 min. Subsequent films can be taken of skeletal injuries found clinically or incidentally on the first three plain radiographs. It is recommended that all emergency rooms should have a ceiling-mounted radiographic unit with an automatic daylight processor to provide the best service for patients with major trauma.
Concentrations of soluble vascular cell adhesion molecule-1 and E-selectin in breast cyst fluid and their relation with cyst type
Authors: Lai L C , Siraj A K , Kadory S , Lennard T W J 
Published: March 2007

Abstract
Gross cystic breast disease may be associated with a higher risk of breast cancer. There are two groups of mammary cysts: those lined by apocrine epithelium (intracystic sodium to potassium (Na:K) ratio &lt; 3) and those lined by flattened epithelium (intracystic Na:K ratio &gt; 3). Cell adhesion molecules may be involved in various stages of tumour metastasis. Intracystic levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) were measured. Significantly greater concentrations of sVCAM-1 and sE-selectin occurred in the high-electrolyte ratio group than in the low (P &lt;0·001). A positive correlation was found between sVCAM-1 and sE-selectin (rS = 0·827, P &lt;0·001) which may be a chance observation or suggest a common mechanism of entry into mammary cysts. The significance of these soluble cell adhesion molecules in breast cyst fluid requires elucidation.
Treatment and survival in 13560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: An epidemiological study
Authors: Bramhall S R , Allum W H , Jones A G , Allwood A , Cummins C , Neoptolemos J P 
Published: March 2007

Abstract
The trends in treatment and outcome of 13560 patients with pancreatic cancer, and in incidence of the disease, in the West Midlands health region were determined between 1957 and 1986 using data from the West Midlands Region Cancer Registry. Patients were divided into those diagnosed in the first 20 years (19570–1976, n = 7888) and the most recent 10 years (1977–1986, n = 5672). The disease was more common in men and the incidence increased up to 1970 after which it levelled off. In the 1977–1986 period a lower proportion of patients had laparotomy alone (825 (14·5 per cent) versus 1552 (19·7 per cent)), a similar proportion had bypass surgery (2010 (35·4 per cent) versus 2760 (35·0 per cent)), while a greater proportion had supportive care (2710 (47·8 per cent) versus 3368 (42·7 per cent)) but the resection rates were the same (145 (2·6 per cent) versus 208 (2·6 per cent)). The 30-day mortality rates between the two periods unproved for resection (40 (27·6 per cent) versus 94 (45·2 per cent)), bypass surgery (436 (21·7 percent) versus 691 (25·0 per cent)) and laparotomy (372 (45·1 per cent) versus 873 (56·3 per cent)). The 12-month survival rate for bypass did not significantly differ during the study (14·9 per cent versus 12·4 per cent) but there was a significant improvement in the 5-year survival for resection (9·7 per cent versus 2·6 per cent, P &lt; 0·015). The resection rates were low and 30-day mortality rates for surgery were high compared with those of other published series.