bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperamylasaemia in ruptured aortic aneurysm: Incidence and prognostic implications
Authors: Bagley J S , Tyler M P H , Cooper G G 
Published: March 2007

Abstract
A study was carried out to determine the incidence of increased serum amylase activity in patients with ruptured aortic aneurysm during the 48 h after presentation and to assess its clinical significance. In a prospective series of 25 patients, hyperamylasaemia occurred in ten and was significantly associated with poor outcome (P=0·005). In patients who died or had a major complication, serum amylase activity was significantly higher than in those who had an uncomplicated postoperative recovery (P&lt;0·05). There was a correlation between preoperative serum amylase activity and length of stay in the intensive care unit after operation (rs=0·78 (95 per cent confidence interval 0·54–0·90), P&lt;0·002). Serum amylase activity may be useful as a prognostic indicator in patients with ruptured aortic aneurysm.
Randomized controlled trial comparing Nissen fundoplication and the Angelchik prosthesis
Authors: Hill A D K , Walsh T N , Bolger C M , Byrne P J , Hennessy T P J 
Published: March 2007

Abstract
Sixty-one patients with gastro-oesophageal reflux refractory to medical therapy were entered into a prospective randomized trial comparing the Rossetti–Hell modification of the Nissen fundoplication (n =31) with the Angelchik prosthesis (n = 30). Mean age, sex ratio, duration of symptoms, preoperative pH profiles and manometric findings were similar in the two groups. At a mean of 84 (range 64–105) months after closure of the trial 47 patients were available for review, eight had died from unrelated causes and six were lost to follow-up. Of the patients reviewed, 28 consented to endoscopy, 25 to oesophageal 24-h pH assessment and 20 to oesophageal manometry. Both fundoplication and the Angelchik prosthesis provided lasting control of gastro-oesophageal reflux, with 20 and 17 patients respectively maintaining a satisfactory outcome. There were no significant differences in pH profile between the groups but the Angelchik prosthesis had to be removed from three patients.
Results of resection for cancer of the exocrine pancreas: A study from the French Association of Surgery
Authors: Baumel H , Huguier M , Manderscheid J C , Fabre J M , Houry S , Fagot H 
Published: March 2007

Abstract
A multicentre retrospective study was carried out to analyse short- and long-term results of 787 pancreatic resections performed for cancer between 1982 and 1988. The postoperative mortality rate was 10 per cent and the morbidity rate 35 per cent. Age above 70 years and systemic organ failure independently influenced operative mortality. In patients surviving more than 30 days the median survival was 12·3 months and the actuarial survival rate at 5 years 12 per cent. The 5-year survival rate was lower for patients with lymph node involvement than for those without (4 versus 20 per cent, P = 0·001). The operative mortality rate was higher after total pancreatectomy than pancreato-duodenectomy (17 versus 8 per cent, P = 0·015). The median survival time and 5-year survival rate after total pancreatectomy and pancreatoduodenectomy were 11 versus 14 months and 3 versus 15 per cent respectively. Of the clinical and pathological factors studied, location of the tumour in the left pancreas was most strongly related to survival, with no survivors at 4 years. These results suggest that resection should be avoided in patients over 70 years old with systemic organ failure. Pancreatoduodenectomy remains the best procedure for resection, total pancreatectomy being performed only in patients with multifocal carcinoma or those in whom a safe pancreatic anastomosis cannot be constructed.
Evaluation of the cost of laparoscopic and open cholecystectomy
Authors: Fullarton G M , Darling K , Williams J , Macmillan R , Bell G 
Published: March 2007

Abstract
Despite the rapid growth of laparoscopic cholecystectomy, the comparative costs of this new procedure and open cholecystectomy remain unknown. In this study the costs have been evaluated of a consecutive series of patients undergoing these procedures in a district general hospital with an established resource management centre. Fifty consecutive patients undergoing open cholecystectomy between June 1988 and July 1990 immediately before the introduction of laparoscopic cholecystectomy and 100 patients undergoing laparoscopic cholecystectomy between August 1990 and June 1992 were studied. Costs estimated prospectively for each patient were compared. The mean cost per patient of open cholecystectomy was estimated at £2102 compared with £2026 for the first 50 patients undergoing the laparoscopic procedure. The mean cost (£1744) for the second 50 patients undergoing laparoscopic cholecystectomy was less than that for either open cholecystectomy (P&lt;&lt;0·005) or the initial 50 laparoscopic operations (P&lt;0·03). Operating theatre costs and equipment costs were higher in both laparoscopic groups. These were offset by the higher nursing and ward costs of open cholecystectomy. For the laparoscopic procedure the operating theatre times and duration of hospital stay were both less in the second 50 patients than in the first 50. After the initial learning period, laparoscopic cholecystectomy is less expensive than the open operation and represents a cost-effective method for treatment of the patient with gallstones.
Metabolic and inflammatory responses after open or laparoscopic cholecystectomy
Authors: Jakeways M S R , Mitchell V , Hashim I A , Chadwick S J D , Shenkin A , Green C J , Carli F 
Published: March 2007

Abstract
Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P&lt;0·001) increased from 342(80) and 424(91) nmol l−1 before operation to 895(46) and 966(53) nmol l−1 after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P &lt; 0·02) at the end of surgery from mean(s.e.m.) preoperative levels of 5·54(0·15) and 6·16(0·15) mmol l−1 to postoperative values of 7·46(0·29) and 8·46(0·86) mmol−1 for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P &lt; 0·02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P &lt; 0·01) during surgery by an equivalent extent from 38·9(0·77) and 38·5(1·10) g l−1 to 35·2(0·79) and 34·6(0·97) g l−1. The mean (95 per cent confidence interval) interleukin (IL) 6 concentration peaked 4 h after surgery at 57·2 (44·6–73·4) pg ml−1 following laparoscopic and 99·3 (72·8–135·4) pg ml−1 after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17·0 (12·7–21·2) and 49·0 (25·3–93·6) mg l−1 and at 48 h 28·0 (21·4–35·4) and 70·0 (36·4–133·6) mg l−1 following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P &lt; 0·01). Mean(s.e.m.) fatigue scores were significantly (P &lt; 0·05) increased from preoperative values of 2·4(0·24) and 2·6(0·44) to 5·5(0·56) and 6·8(0·51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5·6(0·57)) remained significantly (P &lt; 0·05) raised only after open cholecystectomy. Hand grip strength was significantly (P &lt; 0·05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.
Current role of extracorporeal shockwave therapy in surgery
Authors: Plaisier P W , van der Hul R L , Terpstra O T , Bruining H A 
Published: March 2007

Abstract
In urology the introduction of extracorporeal shockwave therapy brought a revolutionary change to the management of urinary calculi. This inspired the introduction of shockwave therapy in several fields of surgery; it has been applied as a potential alternative to several operative procedures but is still experimental. So far, the major application of shockwave therapy has been lithotripsy of stones in the gallbladder, common bile duct, pancreatic duct and salivary gland ducts. Other applications are in the non-operative management of bone healing disturbances and in the inhibition of tumour growth. Steps towards selective thrombus ablation and pretreatment of heavily calcified arteries have also been made. In this review, the applications of extracorporeal shockwave therapy in several areas of surgery are discussed. It is concluded that, for selected patients, shockwave treatment may serve as a useful addition to the surgical armamentarium.
Reliability of ankle: Brachial pressure index measurement by junior doctors
Authors: Ray S A , Srodon P D , Taylor R S , Dormandy J A 
Published: March 2007

Abstract
Ankle: brachial pressure index (ABPI) measurements are often performed by junior medical staff with little experience of the technique. The accuracy of such measurements is unknown. Two newly qualified doctors with no training in the use of Doppler ultrasonographic flowmeters performed ABPI measurement in 38 limbs (experiment 1). Two other newly qualified doctors then underwent a formal training session before, as well as continuous instruction during, ABPI measurements in 23 limbs (experiment 2). The doctors' measurements were compared with those obtained by experienced vascular technicians. The mean difference in ABPI measurement between the doctors and technicians in experiment 1 was greater than that in experiment 2 at both the dorsalis pedis (P&lt;0·05) and posterior tibial arteries. Nearly 30 per cent of the doctors' ABPI measurements in experiment 1 differed from those of the technicians by more than 0–15, in comparison with only 15 per cent of the measurements performed in experiment 2. Junior doctors should undergo formal training before performing ABPI measurements.
Prediction of outcome using the Mannheim peritonitis index in 2003 patients
Authors:   The Peritonitis Study Group, Billing A , Fröhlich D , Schildberg F W 
Published: March 2007

Abstract
Early prognostic evaluation of abdominal sepsis is desirable to select high-risk patients for more aggressive therapeutic procedures and to provide objective classification of the severity of disease. The reliability of the Mannheim peritonitis index was assessed and its predictive power for different populations examined in a study of 2003 patients from seven centres in three European countries. The prevalence of risk factors varied considerably between the groups. For a threshold index score of 26, the sensitivity was 86 (range 54–98) per cent, specificity 74 (range 58–97) per cent and accuracy 83 (range 70–94) per cent in predicting death. For patients with a score less than 21 the mean mortality rate was 2·3 (range 0–11) per cent, for score 21–29 22·5 (range 10·6–50) per cent and for score greater than 29 59·1 (range 41–87) per cent. The mean index score and mean mortality rate correlated in the different groups, reflecting a homogeneous standard of therapy for peritonitis. The Mannheim peritonitis index provides an easy and reliable means of risk evaluation and classification for patients with peritoneal inflammation.
Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer
Authors: Saad Z , Bramwell V , Duff J , Girott M , Jory T , Heathcote G , Turnbull I , Garcia B , Stitt L 
Published: March 2007

Abstract
Recent studies have suggested that the timing of surgery in relation to the menstrual cycle might influence survival of premenopausal women with operable breast cancer. The data of 96 premenopausal patients who underwent primary surgery for operable breast carcinoma between 1975 and 1988 were analysed. At 10 years, disease-free and overall survival rates of patients whose initial surgery was 1–12 days after the starting date of the last menstrual period (follicular phase) were significantly poorer compared with survival of those who underwent operation more than 12 days after the last menstruation (luteal phase) (disease-free survival rate 40 versus 72 per cent, P = 0·002; overall survival rate 40 versus 79 per cent, P = 0·001). These differences in survival remained significant in a second analysis based on the menstrual phase at the time of both initial and definitive operation. Menstrual phase had the greatest impact on the survival of patients with positive axillary nodes (P = 0·009). Prospective studies are required to elucidate the relationship between the timing of all surgical procedures during the menstrual cycle and survival.
Stereotactic cytology in a regional breast-screening programme
Authors: Kerin M J , Williams N N , Cronin K J , Dervan P , Ennis J , Dowling M , Fitzpatrick J M , Gorey T F 
Published: March 2007

Abstract
Stereotactic localization and fine-needle aspiration are new procedures for the management of non-palpable mammographic abnormalities. In this prospective study, stereotactically guided cytology with immediate reporting was performed before biopsy in a consecutive series of 166 patients with screen-detected non-palpable abnormalities. All specimens were obtained by multiple stereotactically guided passes with a 22–G Franzén needle and graded as: 1, acellular or inadequate; 2, benign; 3, atypical, probably benign; 4, probably malignant; or 5, malignant. After definitive surgery all tumours were staged according to the Union Internacional Contra la Cancrum classification. Of 71 patients with malignancy, 56 were correctly diagnosed by cytology before operation. Twelve patients with malignancy had grade 1 cytology and 50 of the 52 with grade 2 cytology had benign disease. This study confirms that stereotactic cytology is a valuable diagnostic test in a breast-screening programme.
Radical systematic mediastinal lymphadenectomy in non-small cell lung cancer: A randomized controlled trial
Authors: Izbicki J R , Thetter O , Habekost M , Karg O , Passlick B , Kubuschok B , Busch C , Haeussinger K , Knoefel W T , Pantel K , Schweiberer L 
Published: March 2007

Abstract
The value of radical systematic lymphadenectomy in the treatment of bronchial carcinoma is controversial. In a randomized controlled clinical trial, radical lymphadenectomy was compared with conventional node dissection in 182 patients with non-small cell lung cancer. Comparison of short-term results revealed a significantly longer operating time in those undergoing systematic lymphadenectomy, but overall morbidity and mortality rates were comparable between groups. However, there were complications associated with radical lymphadenectomy such as prolonged air leakage and haemorrhage. Interim analysis of results at a median follow-up of 26·8 months showed no significant influence of radical lymphadenectomy on local recurrence-free interlval, metastasis-free interval or cancer-related survival. In conclusion, radical systematic lymphadenectomy is a safe operation that leads to a better staging of non-small cell lung cancer, but its prognostic benefit is questionable.
Implications of upright gastro-oesophageal reflux
Authors: Gillen P , Thornton J , Byrne P J , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
The presentation, oesophageal profile and management of 27 symptomatic patients with daytime (upright) gastrooesophageal reflux only is reported. Oesophagitis was a presenting feature in 11 patients and its development was most closely correlated with postprandial reflux, which was characterized by cumulative acid exposure rather than by clearance abnormalities. Upright reflux was not associated with a hypotensive lower oesophageal sphincter or with oesophageal dysmotility. Antireflux surgery is indicated when conservative measures fail and was not associated with gas-bloat syndrome after operation.
Highly selective devascularization for bleeding oesophagogastric varices
Authors: Yassin Y M , Eita M S , El-Mirghani M 
Published: March 2007

Abstract
Between 1975 and 1984, 419 patients with bleeding oesophagogastric varices were subjected to the simplified operation of highly selective devascularization. All but three were available for follow-up at 5–10 years. The overall mortality rates for urgent and elective operation were 8 and 2 per cent respectively. The overall recurrent bleeding rates at 1, 5 and 10 years were 8 per cent, 13 per cent (15 per cent of survivors) and 17 per cent (24 per cent of survivors). The overall survival rates at 1,5 and 10 years were 87,76 and 57 per cent. Recurrent bleeding was usually controlled by endoscopic sclerotherapy and less often by reoperation. Highly selective devascularization controlled bleeding in emergency and elective situations without compromising hepatic function.
Use of Marlex mesh in the repair of recurrent incisional hernia
Authors: Liakakos T , Karanikas I , Panagiotidis H , Dendrinos S 
Published: March 2007

Abstract
Recurrent incisional hernia remains a major problem for the general surgeon. The rate of recurrence of hernia repaired by primary closure using nylon sutures or with knitted monofilament polypropylene (Marlex) mesh was studied. A total of 102 repairs were performed over a 19-year period. Marlex mesh was used in 49 cases and primary closure in 53. All except two patients were followed from 1 to 15 (mean 7·6) years or to death. The incidence of recurrence was 8 per cent when Marlex was used and 25 per cent after primary closure. In both groups the majority of the recurrences were in the first 16 months after repair. The use of Marlex mesh should be considered in the management of recurrent incisional hernia.
Improved sensitivity of colour Doppler flow imaging of colorectal hepatic metastases using galactose microparticles: A preliminary report
Authors: Leen E , Angerson W J , Warren H W , O'Gorman P , Moule B , Carter E C , McArdle C S 
Published: March 2007

Abstract
The clinical application of ultrasonographic contrast agents in colour Doppler flow imaging of hepatic tumours is receiving increasing attention. Levovist is a suspension of galactose microparticles that provides reproducible concentrations of stabilized air bubbles with transpulmonary stability. Its effect on colour Doppler imaging was assessed in 26 patients with colorectal cancer and histologically proven hepatic metastases. Colour Doppler flow imaging was performed before and after intravenous injection of 10ml Levovist 300mg/ml. At 5–10 s after injection there was significant enhancement of the hepatic lesions with colour Doppler signals in 23 patients, lasting for a mean(s.d.) of 180(45) s. A consistent pattern of colour Doppler signal was observed, with increased enhancement predominantly around the tumour periphery and little or no central enhancement. These data suggest that Levovist may increase the sensitivity and specificity of colour Doppler flow imaging of colorectal hepatic metastases.
Efficacy of octreotide in the prevention of complications of elective pancreatic surgery
Authors:   The Italian Study Group, Pederzoli P , Bassi C , Falconi M , Camboni M G 
Published: March 2007

Abstract
A placebo-controlled double-blind multicentre study, with randomization into parallel groups, was performed to determine whether perioperative subcutaneous administration of octreotide 0·1 mg every 8 h reduces the rate of complications specifically related to pancreatic surgery. In all, 252 patients were evaluated (153 men, 99 women; mean(s.e.m.) age 53·1(0·8) years) who had pancreatic or periampullary tumour or other duodenal disease (157 patients) or chronic pancreatitis (95) and were undergoing elective pancreatic resection (100 Whipple's procedure, 60 distal resection, 12 others), pancreaticojejunostomy (66) or enucleation of pancreatic lesions (14). The proportion of patients with complications was significantly lower in the group treated with octreotide than in the placebo group (15·6 versus 29·2 per cent, P = 0·01). Octreotide thus appears to reduce substantially the risk of complications related to elective pancreatic surgery. Moreover, treatment acceptability was high.
Postoperative immunological function and jaundice
Authors: Regan M C , Keane R M , Little D , Bouchier-Hayes D 
Published: March 2007

Abstract
The effects of operative trauma and obstructive jaundice on systemic immunity were studied in a rat model, using the delayed-type hypersensitivity response to 2,4-dinitro-1-fluorobenzene as a measure of systemic immune responsiveness. Midline laparotomy caused a significant decrease in the mean(s.e.m.) delayed-type hypersensitivity response 1 week after operation (4·6(1·3) versus 19·0(2·2) per cent for controls). The response returned to control leyels by 2 weeks (14·6(3·1) per cent). Common bile duct ligation and division resulted in a significantly depressed hypersensitivity response at 2 and 3 weeks (6·8(2·0) and 8·4(1·6) per cent respectively). The expected decrease in the response at 1 week in these animals was not observed (mean(s.e.m.) 12·7(2·7) per cent), suggesting a possible role for the normal liver in the induction of postoperative immune depression. Impaired function of the reticuloendothelial system was induced in non-jaundiced animals by Kupffer cell ablation following intraportal infusion of λ-carrageenan. A similar prevention of postoperative immune hyporesponsiveness was observed (mean(s.e.m.) 10·4(1·0) versus 10·4(1·6) per cent for controls). Hepatic Kupffer cells play an important role in the induction of postoperative immune depression.
Peritoneal aspiration cytology as a diagnostic aid in acute appendicitis
Authors: Caldwell M T P , Watson R G K 
Published: March 2007

Abstract
A total of 110 consecutive patients presenting to one surgical firm with suspected acute appendicitis underwent peritoneal aspiration cytology. Aspiration was successful in 108 patients and 44 were positive. Patients with a positive result underwent emergency surgery; 42 had histologically proven acute appendicitis and two peritonitis of other causes. Seven patients with a negative result underwent appendicectomy; four had acute appendicitis and three a normal appendix. Peritoneal aspiration cytology had a sensitivity for acute appendicitis of 91 per cent and a specificity of 94 per cent. The positive predictive value of the test was 95 per cent and the negative predictive value 94 per cent. The negative appendicectomy rate was 10 per cent overall and 11 per cent in women of reproductive age. Peritoneal aspiration cytology is a useful diagnostic test in the management of patients with suspected acute appendicitis.