bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoluminal transfemoral abdominal aortic aneurysm repair with aorto-uni-iliac graft and femorofemoral bypass
Authors: Yusuf S W , Baker D M , Hind R E , Chuter T A M , Whitaker S C , Wenham P W , Gregson R H S , Hopkinson B R 
Published: March 2007

Abstract
Endoluminal transfemoral repair of abdominal aortic aneurysm (AAA) is an important development but large aneurysms seldom have a distal neck suitable for the currently available devices for a straight aortoaortic graft1–3. A bifurcated graft system overcomes the limitation of lack of distal neck but it is unsuitable for a significant proportion of aneurysms because of a wide or aneurysmal iliac vessel1. An alternative technique of aorto-uni-iliac graft with occlusion of the contralateral common iliac with embolization and a femorofemoral crossover graft is described.
Effect of postoperative insulin-like growth factor I supplementation on protein metabolism in humans
Authors: Leinsköld T , Permert J , Olaison G , Larsson J 
Published: March 2007

Abstract
Insulin-like growth factor I (IGF-I) has been shown experimentally to exert a nitrogen-sparing effect in both animals and humans. Its effects on protein metabolism during the first 5 days after radical large bowel resection were investigated. Nineteen patients were randomly allocated to receive either human recombinant IGF-I (2 × 80 μ/kg body weight subcutaneously, n = 10) or placebo (n = 9) starting on the morning of the first day after operation. All patients received parenteral nutrition (glucose 3 g and nitrogen 0.1 g/kg/day). The mean(s.e.m.) urinary nitrogen: creatinine ratio was significantly reduced in patients who received IGF-I compared with those given placebo (275.0(17.1) compared with 386.3(23.6), P&lt;0.01). The mean urinary 3-methylhistidine: creatinine ratio and nitrogen balance were lower in the IGF-I group, but not significantly so. Plasma IGF-I concentrations were four times higher in the treated group compared with those in the placebo group. Insulin-like growth factor binding protein 3 (IGFBP-3) increased significantly after the start of IGF-I treatment, compared with mean postoperative levels. The mean blood glucose concentration was significantly lower in the IGF-I group than the placebo group (P &lt; 0.05) but no patient had a hypoglycaemic attack. The authors conclude that IGF-I does not significantly influence the nitrogen balance, but that results indicate a possible nitrogen-sparing effect in patients after major abdominal operations. IGF-I therapy is safe, and may be of value in catabolic patients after serious injury and major operations.
Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism
Authors: Bartsch D , Nies C , Hasse C , Willuhn J , Rothmund M 
Published: March 2007

Abstract
The incidence of double parathyroid adenoma in 277 prospectively documented patients suffering from primary hyperparathyroidism was 5.4 per cent (15 patients). Patients with double adenoma were all symptomatic and had a significantly higher parathyroid hormone (PTH) level and tumour weight than those with a solitary adenoma or four-gland hyperplasia. In 11 patients the adenomas were located bilaterally. Bilateral neck exploration must be performed routinely to deal successfully with this condition at initial operation. In six patients one enlarged gland was found in the thymus or posterior mediastinum. These locations should be explored, especially in patients with high PTH levels, in those in whom all four parathyroid glands cannot be detected or if only one small adenoma is found. In all such patients, selective resection of the enlarged parathyroid glands resulted in normocalcaemia (median follow-up 3.5 years). Selective resection of the pathological glands is the treatment of choice.
Simple method of orientating breast biopsies following hook-wire or ultrasonographic localization of impalpable mammographic abnormalities
Authors: D'Costa H , Barham C P , Jones P A , Teasdale C , Watkins R M 
Published: March 2007

Abstract
Localization of impalpable breast lesions with fine wires is standard practice and several variations of the hook-wire device have been described1. More recently ultra-sonography2 has been used as an accurate and rapid method of preoperative localization of mass lesions. Accurate biopsy of all clinically impalpable suspicious mammographic abnormalities is essential and complete excision is important in those patients with malignant disease3. Having performed a localization biopsy, precise specimen orientation allows further excision if original margins are involved. A simple and inexpensive method of orientating tissue specimens following excision biopsy is described.
Analysis of 8651 appendicectomies in England and Wales during 1992
Authors: Baigrie R J , Dehn T C B , Fowler S M , Dunn D C 
Published: March 2007

Abstract
In 1990 the Royal College of Surgeons of England established the Comparative Audit Service to enable surgeons to compare their results with those of other colleagues. In addition, the large volume of collected data provides insight into national patterns of surgical practice. In 1992 data were collected for a range of operations including appendicectomy, resulting in by far the largest single analysis in the international literature of this common surgical problem.
Expression of tenascin in gastric carcinoma
Authors: Ilunga K , Iriyama K 
Published: March 2007

Abstract
Tenascin expression was determined by an immuno-histochemical technique in 120 surgical specimens of gastric carcinoma to investigate its relationship with clinicopathological factors. Tenascin expression was more prominent in the neoplastic area than in the adjacent non-neoplastic mucosa. Tenascin was frequently observed in gastric mucosa with diffuse chronic gastritis, glandular atrophy and intestinal metaplasia. In the neoplastic area, tenascin expression was positive in 72 cases (60 per cent). Tumours with a high frequency of tenascin expression included: Borrmann type II (19 of 20), well or moderately differentiated tumours (52 of 63), tumours with expansive growth and with an intermediate growth pattern (40 of 42), and those with a medullary or intermediate-type stroma (55 of 73). There was no significant relationship between tenascin expression and age, sex, depth of tumour invasion, lymph node metastasis, invasion to lymphatic vessel, venous invasion and the 4-year survival rate.
Management of bile leaks after laparoscopic cholecystectomy
Authors: Barton J R , Russell R C G , Hatfield A R W 
Published: March 2007

Abstract
The success of laparoscopic cholecystectomy has been tarnished by the increased risk of bile duct damage associated with the operation. Many of these injuries can be managed by endoscopic techniques. Experience of such injuries between 1991 and 1994 was reviewed. Twenty-four patients were referred: 11 with injuries to the cystic duct alone, five with complete hepatic duct obstruction and eight with high bile duct leaks. All patients with leaks from the cystic duct were managed successfully endoscopically (sphincterotomy, four; stent, seven) without recourse to further surgery. Patients with complete obstruction were aided in their recovery by endoscopic and percutaneous techniques, either for postoperative problems (two patients) or in preparation for surgery (three). The eight patients with high bile duct leaks were managed endoscopically by stenting (seven patients) or sphincterotomy (one). Stenting appeared to encourage leaks to heal better than sphincterotomy alone; stents should probably be left in situ for 2 months before removal. There were no deaths and all but one patient had normal biliary function at follow-up. It is suggested that all suspected injuries after biliary surgery require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be required only if there is complete obstruction of the biliary tree.
Transplantation for fulminant and subfulminant hepatic failure with preservation of portal and caval flow
Authors: Belghiti J , Noun R , Sauvanet A , Durand F , Aschehoug J , Erlinger S , Benhamou J P , Bernuau J 
Published: March 2007

Abstract
This article describes experience with preservation of portal and caval flow during orthotopic liver transplantation (OLT) for fulminant or subfulminant hepatic failure (FSHF) as an alternative to venous bypass. As a modification of the standard procedure, hepatectomy and graft implantation were performed with preservation or caval patency in combination with a temporary portocaval shunt. From July 1991 to March 1994, 25 consecutive patients with FSHF underwent OLT with preservation of portal and caval flow. All patients had severe confusion (n = 9) or coma (n = 16) with a mean(s.d.) clotting factor V of 13(5) per cent and a mean(s.d.) serum bilirubin level of 408(151) μmol/l. During the anhepatic phase, haemodynamic data showed a preservation of cardiac filling pressure, mean arterial pressure, and renal perfusion pressure, while the mean(s.d.) urine flow was maintained at 182(120) ml/h. Venous bypass was not required. There were three (12 per cent) deaths after the operation, and all survivors made a full neurological recovery. Normal postoperative creatinine values allowed the early use of baseline immunosuppression. The authors conclude that, in patients with FSHF, successful liver transplantation can be achieved with this technical procedure.
Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy
Authors: Ho Y-H , Foo C L , Seow-Choen F , Goh H S 
Published: March 2007

Abstract
A prospective randomized controlled trial was carried out on the effects of Daflon 500 mg (a micronized flavonidic fraction containing diosmin 450 mg and hesperidin 50 mg) on bleeding after haemorrhoidectomy. In all, 228 consecutive patients with prolapsed irreducible piles were recruited. Elective haemorrhoidectomy was performed with a standardized diathermy excision method. Some 114 patients were randomized to receive Daflon 500 mg for 1 week after operation (group 1), and there were 114 controls (group 2). Postoperative analgesia and laxative prescription as well as hospital stay were otherwise the same. One patient (0·9 per cent) from group 1 and seven (6·1 per cent) from group 2 had postoperative bleeding (P=0·03). All bleeding occurred from 6 to 15 days after haemorrhoidectomy. There were no side-effects from the use of Daflon 500 mg. The risk of secondary bleeding from haemorrhoidectomy is reduced with postoperative Daflon.
Experimental study to show that growth hormone treatment before trauma increases glutamine uptake in the intestinal tract
Authors: Mjaaland M , Unneberg K , Jenssen T G , Revhaug A 
Published: March 2007

Abstract
This study examined whether growth hormone treatment deprived the intestinal tract of glutamine after trauma. Piglets were treated with growth hormone 24 units daily 3 days before and at the start of the trauma (GH-3, n = 8) or at the start of the trauma only (GH-i, n = 8). Eight piglets acted as non-treated controls. The trauma consisted of a standardized abdominal surgical procedure. Primed constant infusions of U-14C-glutamine were given. Intestinal, hepatic, renal and hindleg—glutamine fluxes were measured. Growth hormone treatment increased mean(s.e.m.) net intestinal glutamine uptake: GH-3, 39·7(9·4) and 48·7(12·7) μmol/min; GH-1, 33·2(5·5) and 25·7(12·3) μmol/min; controls, 19·5(10·3) and 2·0(15·3) μmol/min at 1 h and 5 h after trauma, respectively, (P = 0·02). The treatment increased glutamine oxidation (P = 0·025), and decreased hindleg glutamine net (P = 0·0052) and absolute release (P = 0·0063), glutamine rate of appearance (P = 0·01), and percentage of glucose coming from glutamine (P = 0·05). Growth hormone treatment before trauma increased mtestinal glutamine uptake.
Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing
Authors: Osther P J , Gjøde P , Mortensen B B , Mortensen P B , Bartholin J , Gottrup F 
Published: March 2007

Abstract
A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P 0·04). Monofilament polyglyconate suture does not reduce the incidence of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture.
Upper-limb arterial disease in women treated for breast cancer
Authors: Taylor P J , Cooper G G , Sarkar T K 
Published: March 2007

Abstract
A 5-year cohort of patients treated 15–19 years previously for breast cancer was studied to establish the prevalence of symptoms and objective evidence of circulatory insufficiency in the upper limbs. There were 187 survivors of the original cohort of 665. In all, 102 patients were evaluated; 50 had received radiotherapy in addition to surgery. Irradiated and non-irradiated groups were comparable for age, extent of axillary dissection and vascular risk factors. Both arms were assessed for symptoms and examined by Doppler ultrasonographically derived segmental pressures and hyperaemia testing, Doppler ultrasonographic waveform analysis, pulse volume recording and venous outflow air plethysmography. Seven ipsilateral arms (14 per cent) in patients given radiotherapy were symptomatic, compared with four (8 per cent) in those receiving surgery alone, and two contralateral control arms (2 per cent). Evidence of arterial disease was found in 11 ipsilateral arms of patients given radiotherapy (22 per cent) and two ipsilateral arms of those receiving surgery alone (4 per cent) (P &lt; 0·03). There was no association between symptoms and evidence of arterial disease, and no evidence of abnormal venous function.
Effect of aberrant hepatic arterial anatomy on tumour response to hepatic artery infusion of floxuridine for colorectal liver metastases
Authors: Burke D , Earlam S , Fordy C , Allen-Mersh T G 
Published: March 2007

Abstract
Regional hepatic artery infusion of colorectal liver metastases produces the highest reported treatment response. The effect of variation in hepatic artery anatomy on tumour response to regional floxuridine (FUdR) was studied. Aberrant hepatic arterial anatomy occurred in 13 of 74 patients (18 per cent) who underwent cannulation of the hepatic artery and infusion of FUdR for colorectal liver metastases. The non-dominant hepatic artery was ligated and the dominant artery cannulated in those with aberrant anatomy. Despite evidence of a collateral circulation to the non-dominant area of the liver in these patients, there was no significant reduction in median tumour volume with treatment (before treatment 214 ml, after treatment 339 ml). By contrast, there was a significant (P &lt; 0·001) decrease in median tumour volume (before treatment 329 ml, after treatment 148 ml) in those with normal anatomy. Delivery of FUdR to metastases via an intrahepatic collateral circulation was not as effective as through a main hepatic artery.
Tissue factor expression correlates with histological grade in human pancreatic cancer
Authors: Kakkar A K , Lemoine N R , Scully M F , Tebbutt S , Williamson R C N 
Published: March 2007

Abstract
The transmembrane cellular receptor tissue factor (TF) is the primary initiator of the coagulation cascade in man. Expression of TF was determined in 55 specimens of ductal adenocarcinoma of the pancreas and was found to correlate strongly with the degree of histological differentiation. A significant linear trend was observed with stronger immunoreactivity observed in poorly differentiated tumours (X2 = 6·69, P = 0·0098). No TF staining was seen in pancreatic samples from normal controls (n = 18). As expression of TF may be associated with tumour progression, its analysis could provide useful prognostic information in patients with pancreatic malignancy.
Inflammatory bowel disease in primary sclerosing cholangitis: An analysis of patients undergoing liver transplantation
Authors: Miki C , Harrison J D , Gunson B K , Buckels J A C , McMaster P , Mayer A D 
Published: March 2007

Abstract
Fifty-five patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) were reviewed retrospectively. After OLT there were significantly more episodes of acute rejection in 31 patients with a previous history of inflammatory bowel disease (IBD) than in 24 without such a history. Patients who had severe acute rejection were significantly younger at diagnosis of IBD. Five patients with histological features suggestive of recurrent PSC after OLT were significantly younger at the time of transplantation than those who did not develop recurrence. Patients with poor control of IBD after OLT had a significantly lower age at diagnosis of bowel inflammation. The presence of IBD did not affect the outcome after OLT, but was associated with a higher rate of acute rejection. Younger patients had a greater risk of developing severe rejection, recurrent PSC and poor control of IBD after liver transplantation.
Effective administration of heparin and antibiotic prophylaxis
Authors: Avery C M E , Jamieson N , Calne R Y 
Published: March 2007

Abstract
A prospective audit was performed to determine whether new departmental procedures had improved the administration of heparin and antibiotic prophylaxis in patients undergoing major surgery who were at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The results are compared with a previous retrospective audit of the same ‘at-risk’ groups. A significant improvement in prophylaxis administration is demonstrated.
Local excision of rectal tumours
Authors: Banerjee A K , Jehle E C , Shorthouse A J , Buess G 
Published: March 2007

Abstract
Local excision of colorectal tumour may be palliative or curative. Recent advances in minimal access techniques have allowed curative excision to be offered to a wider range of patients. Absolute indications for potentially curative local excision include mobile tumours, T1 tumours (assessed by ultrasonography), well or moderately differentiated histology (determined by biopsy) and tumour size less than 3 cm. Relative indications include T2 and T3 tumours (by ultrasonography), poorly differentiated histology (by biopsy) and tumour size greater than 3 cm depending on patient fitness. The rationale for these recommendations is described in detail.
Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction
Authors: Gee A S , Durdey P 
Published: March 2007

Abstract
A proportion of patients with faecal incontinence experience debilitating urgency of defaecation and urge incontinence. This study prospectively assessed 56 faecally incontinent patients by means of standard interview, physical examination and anorectal physiology. Patients with urge incontinence, when compared with those without urge incontinence, were symptomatically worse, had had more vaginal deliveries and had more bowel actions each day. Physiological tests included anal manometry, anal electrosensitivity, pudendal nerve terminal motor latency and a standard proctometrogram. The only physiological differences between the groups were a reduction in voluntary squeeze pressure (median (interquartile range (i.q.r.)) 43 (26–67) versus 67 (45–122) mmHg, P = 0.01) and a smaller percentage change in pressure-volume, an integral of sphincter length and squeeze (median (i.q.r.) 43.5 (0–289) versus 247 (71–455), P = 0.02), in those with urgency. The authors conclude that urge incontinence is associated with impairment of the striated musculature of the anal sphincter complex.
Nitrergic inhibitory innervation of porcine rectal circular smooth muscle
Authors: Stebbing J F , Brading A F , Mortensen N J McC 
Published: March 2007

Abstract
This study was performed to determine whether nitric oxide contributes to inhibitory non-adrenergic non-cholinergic (NANC) neurotransmission in the circular smooth muscle layer of pig rectum. Smooth muscle strips were mounted for isometric tension recording in superfusion organ baths. In the presence of atropine sulphate and guanethidine, transmural electrical field stimulation (EFS) produced frequency-dependent relaxation of precontracted muscle strips. Nω-nitro-l-arginine (l-NOArg), a powerful competitive antagonist of nitric oxide synthase, reduced the relaxant response in dose-dependent fashion; this response was maximally reduced by mean(s.e.m.) 86.5(2.6) per cent (P = 0.0003) at a concentration of 3 × 10−5 mol/l l-NOArg. The response was restored by the addition of l-arginine. Sodium nitroprusside, an exogenous donor of nitric oxide, mimicked the relaxant response. Responses to EFS were abolished by tetrodotoxin. These results suggest that inhibitory NANC neurotransmission in this tissue is mediated, at least in part, by nitric oxide. The failure of l-NOArg to completely abolish the relaxant response suggests that additional neurotransmitters may be involved.
Primary soft tissue sarcoma of the extremities in adults
Authors: Karakousis C P , Proimakis C , Walsh D L 
Published: March 2007

Abstract
The modern literature on adult extremity sarcoma implies that adjuvant therapy (usually irradiation) is mandatory for adequate local control, at least in patients with high-grade tumours undergoing limb-sparing procedures. In 152 primary extremity soft tissue sarcomas, wide or radical resection was employed (116 patients) including amputation in nine patients (6 per cent), or local excision followed by adjuvant postoperative radiation therapy (36). Local recurrence alone occurred in 5 per cent of patients, and in combination with distant metastases in 9 per cent. The total rate of local recurrence was 10 per cent after wide resection (with or without chemotherapy) and 25 per cent after conservative resection and radiotherapy (with or without chemotherapy). Limb sparing was possible in 94 per cent of patients. The majority (76 per cent) had surgical resection alone as local treatment with satisfactory results. Wide resection, when feasible, provides acceptable local control and may be preferable to local excision plus radiation therapy.
Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischaemic rest pain or ulceration
Authors: Ray S A , Minty I , Buckenham T M , Belli A-M , Taylor R S , Dormandy J A 
Published: March 2007

Abstract
The role of percutaneous transluminal angioplasty in the management of severe leg ischaemia is controversial. To investigate further the efficacy of angioplasty and the clinical consequences of restenosis, a randomly selected cohort of 29 patients with ischaemic rest pain or ulceration was studied for 6 months after a technically successful balloon angioplasty. All patients had digital subtraction arteriography at the end of follow-up. Seven of 15 patients undergoing the procedure for rest pain had sustained relief from the initial dilatation. Partial or complete healing was noted in all 14 patients with ulceration and was maintained at 6 months in 11 despite significant (greater than 30 per cent) restenosis at the angioplasty site in eight. There were no complications or clinical deterioration associated with the procedure. Angioplasty is an effective method for treating the severely ischaemic leg, especially when used to achieve ulcer healing; restenosis is often clinically unimportant.