bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative measurement of colonic anatomy and attachments with relevance to colonoscopy
Authors: Saunders B P , Phillips R K S , Williams C B 
Published: March 2007

Abstract
This study examined the variations in colonic length and mesenteric attachments in 118 patients undergoing laparotomy. Measurements were taken according to a set protocol with the bowel pulled medially, or towards the pubic symphysis or the xiphisternum, mimicking the possible displacements that may occur during colonoscopy. A free sigmoid loop was not present in 20 patients (17 per cent) because of adhesions. A descending mesocolon of 10 cm or more in length was recorded in ten patients (8 per cent) and an ascending mesocolon 10 cm or greater in 11 (9 per cent). Some 24 patients (20 per cent) had mobile splenic flexures and in 34 (29 per cent) the mid-transverse colon reached the symphysis pubis or lower when pulled downwards. Mean (range) total colonic length was 114.1 (68–159) cm. This study helps define anatomical variations that may affect the facility, or otherwise, of colonoscopy.
Cusum as an aid to early assessment of the surgical trainee
Authors: van Rij A M , McDonald J R , Pettigrew R A , Putterill M J , Reddy C K , Wright J J 
Published: March 2007

Abstract
Tests of knowledge, aptitude and psychomotor skills have been used to assess and select surgical trainees but none of these is reliable in the long term. The industrial quality-control method of the cusum was used to assess performance progress in 17 surgical trainees. Trainees were assessed on their ability to perform, independently, selected surgical operations using the criterion of procedure duration. Cusum profiles were compared with scores from at least four independent assessors using a modified Royal Australasian College of Surgeons' mentor form. The cusum identified all trainees who were considered either satisfactory or less able by their mentors. This objective evaluation was reliable after 25 procedures, whether for appendicectomy or combined with herniorrhaphy and cholecystectomy. Evaluation of surgical performance using the cusum may prove to be a more objective tool for assessing surgical trainees than early impressions or less clinically oriented tests.
Impact of fine-needle aspiration cytology, ultrasonography and mammography on open biopsy rate in patients with benign breast disease
Authors: Green B , Dowley A , Turnbull L S , Smith P A , Leinster S J , Winstanley J H R 
Published: March 2007

Abstract
The management of breast disease has been influenced by breast imaging and fine-needle aspiration cytology (FNAC) for preoperative diagnosis. To investigate the impact of introducing an in-clinic FNAC service on patient management, the pathology records of patients presenting before and after introduction of the service were studied. Four management changes emerged. The number of patients investigated by histology and/or cytology increased (from 266 to 503), as did specimen numbers (392 to 728). The use of pathological services changed, with more cytology specimens (39 to 554), fewer needle-core biopsies (62 to three) and fewer excision biopsies (245 to 118). The number of patients admitted for surgery fell, especially those with a benign histological diagnosis (174 to 49). These figures demonstrate a change in the management of benign breast disease, from surgery with histopathological diagnosis to cytological diagnosis with surgery only if indicated clinically or from imaging.
Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy
Authors: Kuvshinoff B W , Armstrong J G , Fong Y , Schupak K , Getradjman G , Heffernan N , Blumgart L H 
Published: March 2007

Abstract
Twelve patients with irresectable or recurrent hilar cholangiocarcinoma were treated with internal biliary drainage followed by intraluminal (iridium-192) and external-beam radiotherapy. Biliary drainage was accomplished by means of a combined surgical and interventional radiological approach. Initial biliary decompression was performed surgically by tumour resection, intrahepatic biliary enteric bypass or distal biliary-enteric anastomosis with a temporary stent. Maintenance of internal biliary drainage and application of intraluminal radiotherapy were accomplished radiologically with the use of percutaneous dilatation and metallic expandable biliary endoprostheses. Median survival was 14.5 months; all 12 patients survived for at least 6 months. Early complications during radiotherapy were minor and included two patients with cholangitis and one with transient haemobilia. Jaundice was relieved in ten of 12 patients, while episodes of cholangitis were seen during long-term follow-up in 11 (median 1.5 episodes per patient). Internal biliary drainage, in conjunction with radiotherapy, appears to be safe and effective palliation of irresectable or recurrent hilar cholangiocarcinoma. Patients can maintain a reasonable quality of life with an acceptable incidence of cholangitis, without the hindrance of external drainage devices.
Delayed massive haemorrhage after pancreatic and biliary surgery
Authors: van Berge Henegouwen M I , Allema J H , van Gulik Th M , Verbeek P C M , Obertop H , Gouma D J 
Published: March 2007

Abstract
The purpose of this retrospective study was to determine the causes, symptoms and optimal management of massive delayed haemorrhage after pancreatic and biliary surgery. In a series of 686 patients who underwent major pancreatic and biliary surgery between 1983 and 1993, those with massive haemorrhage (necessitating more than 6 units packed cells within 24 h) more than 24 h after the initial surgery were selected. Two groups were formed, according to the aetiology of bleeding: bleeding caused by erosion of a major artery or that from the (gastro)intestinal suture line. The groups were compared with respect to bleeding parameters, symptoms, diagnostic and interventional procedures, and mortality. Massive postoperative haemorrhage occurred in 22 patients (3.2 per cent): 12 (1.7 per cent) with arterial bleeding and ten (1.5 per cent) with suture-line bleeding were identified. Patients with arterial bleeding had a longer interval between initial surgery and haemorrhage (P = 0.02), more frequent septic complications (P=0.03) and had a higher mortality rate than those with suture-line bleeding (50 versus 0 per cent respectively, P=0.02). If minimally invasive diagnostic and therapeutic techniques are not successful, early aggressive surgical intervention is mandatory, including thorough exploration of the area of the resection, ligated artery stumps and inspection of anastomoses by enterotomy.
Incidence, diagnosis and significance of multiple gastric cancer
Authors: Kodera Y , Yamamura Y , Torii A , Uesaka K , Hirai T , Yasui K , Morimoto T , Kato T , Kito T 
Published: March 2007

Abstract
Of 2790 patients with gastric cancer undergoing surgery between January 1978 and December 1993, 160 (with 356 neoplastic lesions) had synchronous multiple cancer. Of these lesions 271 (76 per cent) were early cancers. Only 85 (53 per cent) of the 160 patients were diagnosed before operation as having multiple cancer; 69 further patients (43 per cent) were diagnosed during the course of the operation. Small flat (IIb) and depressed (IIc) type lesions had a propensity to be missed before operation. The incidence of multiple cancer was relatively low, indicating that several microscopic lesions might have been overlooked in this series. There has, however, only been one patient (1 per cent) with subsequent cancer of the gastric remnant of 126 with multiple cancer and postoperative gastric remnants over the past 16 years. This might be because of co-resection of unrecognized lesions by distal gastrectomy in 68 per cent of the patients. Alternatively some microscopic cancers might not invariably be destined to grow into clinically significant lesions over 10 or more years.
Management of the pancreatic stump following pancreaticoduodenectomy
Authors: Sikora S S , Posner M C 
Published: March 2007

Abstract
Pancreaticoduodenectomy is the procedure of choice in patients with periampullary and pancreatic cancers. Dramatic improvements in morbidity and mortality rates following pancreaticoduodenectomy have been reported in the past 5 years. Consequently, the indications for pancreaticoduodenectomy are becoming more liberal, with some authors suggesting its use as a palliative procedure in pancreatic cancer and as definitive treatment for benign diseases such as chronic pancreatitis. Complications are frequently related to the pancreatic stump and can have a fatal outcome. Several methods of managing the pancreatic stump have been described, with variable results. Modifications of standard techniques have evolved over time in an effort to reduce the incidence of major complications. The results of these methods, the role of perioperative adjuncts and the long-term outcome of pancreaticoenteric anastomosis are reviewed.
Bilateral gracilis neosphincter construction for treatment of faecal incontinence
Authors: Kumar D , Hutchinson R , Grant E 
Published: March 2007

Abstract
Neosphincter formation with gracilis muscle is used for faecal incontinence refractory to conservative measures and after failed sphincter repair. In this study both gracilis muscles were used to create a neosphincter to determine whether this provides superior physiological and clinical results. Ten patients of median age 39 (range 18–73) years were treated. The mean resting and squeeze pressures before operation were 16 (range 0–40) and 44 (range 0–68) cmH2O respectively. The operation was covered by a defunctioning loop left iliac fossa colostomy. Nine of the ten patients have had the stoma closed and are fully continent after a mean follow-up of 24 (range 6–40) months. One patient who had an ileoanal pouch and bilateral graciloplasty has urgency of defaecation. None of the patients has to wear a pad or is taking constipating agents. All nine patients have satisfactory evacuation on isotope defaecography and are continent to artificial stool. After operation the mean resting and squeeze pressures were 78 (range 70–112) and 121 (range 90–188) cmH2O respectively. Bilateral graciloplasty provides satisfactory results for grade 4 faecal incontinence refractory to other operative and non-operative measures, and may be an alternative to stimulated dynamic graciloplasty.
Antioxidant consumption during exercise in intermittent claudication
Authors: Khaira H S , Maxwell S R J , Shearman C P 
Published: March 2007

Abstract
Twenty male claudicant patients and nine age-matched controls were exercised on a treadmill. Blood and urine samples were taken before and after exercise. Total antioxidant concentration was measured using an enhanced chemiluminescent assay and microalbuminuria determined by radioimmunoassay. Claudicants had increased microalbuminuria after exercise. Mean(s.e.m.) antioxidant concentrations were similar for patients and controls at rest: 479(28) and 438(23) µmol/l respectively. Claudicants showed a significant decrease in antioxidant concentration 1 min after exercise to 428(27) µmol/l; this returned to 470(30) µmol/1 by 10 min. A correlation was found between the decrease in antioxidant concentration and the increase in microalbuminuria (rs = −0.496, P &lt; 0.05). This study supports the concept of ischaemia-reperfusion injury in claudicant patients and has implications for treatment.
Preoperative intra-aortic ultrasonography to determine resectability in advanced oesophageal cancer
Authors: Akiyama S , Kodera Y , Sekiguchi H , Fujiwara M , Sakamoto J , Kondo K , Ito K , Endo T , Takagi H 
Published: March 2007

Abstract
This study was designed to evaluate the effectiveness of intra-aortic ultrasonography in the preoperative diagnosis of aortic wall invasion by oesophageal cancer. Twenty-four patients with advanced oesophageal cancer underwent the procedure, and aortic invasion was found in seven. In three of these seven patients, the invasion was diagnosed to be limited to the aortic adventitia, enabling preoperative prediction of the resectability of the tumour. The contact angle of the tumour in relation to the descending aorta was more than 90° in six patients, and aortic invasion to all layers was visualized in four by intra-aortic ultrasonography. On the other hand, aortic invasion to the adventitia was found in three of 14 patients in whom the contact angle was less than 90°. Intra-aortic ultrasonography provides important information to help determine the resectability of advanced oesophageaf cancer.
Role of the spleen in lipid metabolism
Authors: Fatouros M , Bourantas K , Bairaktari E , Elisaf M , Tsolas O , Cassioumis D 
Published: March 2007

Abstract
The frequency of ischaemic heart disease observed after splenectomy for trauma and the low cholesterol levels found in patients with hypersplenism are observations that suggest a possible role for the spleen in lipid metabolism and in the aetiology of atherosclerosis. The present study was designed to examine this role in experimental animals. Serum levels of total cholesterol, triglyceride and high-density lipoprotein (HDL) cholesterol were determined in 32 rats. The spleen was removed in 16 rats and the remaining 16 were sham operated. Half of the splenectomized and half of the remaining rats were fed on a diet rich in fat and the two other subgroups were fed normal chow. Blood tests were performed before, and 3 and 6 months after operation. A significant increase in serum triglyceride and decrease in serum HDL cholesterol levels was observed after splenectomy in rats fed normal chow compared with sham-operated rats. An increase in serum triglyceride and a decrease in serum HDL cholesterol levels was observed in both groups of rats fed normal chow plus high-fat cheese. However, these changes were more pronounced in splenectomized rats. These findings suggest that the spleen has a role in lipid metabolism in rats and may therefore influence atherosclerosis.
Quality-of-life assessment in patients undergoing treatment for oesophageal carcinoma
Authors: O'Hanlon D M , Harkin M , Karat D , Sergeant T , Hayes N , Griffin S M 
Published: March 2007

Abstract
In a prospective study of 69 patients being treated for oesophageal carcinoma, quality of life was assessed with the Rotterdam Symptom Checklist, a dysphagia score and an activities of daily living questionnaire. Significant correlations were found between the results of the Rotterdam Symptom Checklist, the dysphagia score and most aspects of the activities of daily living questionnaire. Eighteen patients underwent surgery, 43 radiotherapy or intubation, and eight a combination of surgery and other therapy. Patients undergoing surgery were significantly younger and had better scores in all parameters examined before operation, including significantly better scores in ‘knowledge and communication’ and ‘mobility and fatigue’. The dysphagia score fell significantly after intervention both in patients undergoing surgery alone and in those receiving palliative therapy. The activities of daily living questionnaire showed significant improvements in two parameters in the surgical group (‘self-care’ and ‘eating and drinking’) and in none of the parameters assessed in the palliation group in 16 weeks. Quality-of-life assessment is useful in assessing quality of care and patient well-being after the diagnosis and treatment of oesophageal carcinoma.
Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater
Authors: Roder J D , Schneider P M , Stein H J , Siewert J R 
Published: March 2007

Abstract
Between 1983 and 1994, 66 patients with cancer of the ampulla of Vater were studied to identify prognostic factors and determine who might benefit from radical resection. Three patients (4.5 per cent) died after operation. Radical resection including lymphadenectomy resulted in potentially curative (R0) resection in 92 per cent. The rate of nodal positivity increased with tumour diameter. Patients with up to two positive lymph nodes had a more favourable prognosis than other patients (P &lt; 0.001). Median survival time for all patients was 41 months; the 5-year survival rate was 35 per cent. Radical resection and lymphadenectomy should therefore be the treatment of choice for patients with tumours of the ampulla of Vater.
Risk of further ulcer complications after an episode of peptic ulcer bleeding
Authors: Ng E K W , Chung S C S , Lau J T F , Sung J J Y , Leung J W C , Raimes S A , Chan A C W , Li A K C 
Published: March 2007

Abstract
To identify the risk factors for developing recurrent ulcer complications after recovery from an episode of peptic ulcer bleeding 611 patients admitted with peptic ulcer bleeding were studied. Some 557 (91 per cent) were discharged without operation. A total of 22 patients were lost to follow-up and five were excluded as maintenance H2 blockers were required. Of the remaining 530 patients at risk, 169 (32 per cent) developed another complication (166 bleeding, three perforations) over a median follow-up period of 36 months. Patients with duodenal ulcers at the time of bleeding, previous history of peptic ulcer, previous bleeding, history of dyspepsia longer than 3 months, and a short interval between previous ulcer complications and the index bleed were more likely to develop further complications. Sex, age, smoking, coexisting illness, non-steroidal anti-inflammatory drugs intake and time taken to achieve ulcer healing had no predictive value.
Management and follow-up of 78 giant haemangiomas of the liver
Authors: Pietrabissa A , Giulianotti P , Campatelli A , di Candio G , Farina F , Signori S , Mosca F 
Published: March 2007

Abstract
The natural history and appropriate treatment of giant liver haemangioma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered into a follow-up programme consisting of clinical assessment and abdominal ultrasonography every 6 months. Resection was considered only for symptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean follow-up was 36 months for the resected patients and 55 months for the observed group. Surgery permanently relieved symptoms. No recurrence of haemangioma was observed. Some 32 of 36 unresected lesions followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a further indication for resection and justifies strict imaging follow-up. The pattern of growth, rather than absolute size, of a lesion is suggested for selection of asymptomatic patients who might benefit from preventive surgical excision. When feasible, the authors prefer enucleation to remove giant haemangiomas.
Early localization of necrosis by contrast-enhanced computed tomography can predict outcome in severe acute pancreatitis
Authors: Kemppainen E , Sainio V , Haapiainen R , Kivisaari L , Kivilaakso E , Puolakkainen P 
Published: March 2007

Abstract
A total of 161 primary contrast-enhanced computed tomography (CT) scans of patients with acute necrotizing pancreatitis taken between 1982 and 1994 were analysed retrospectively. The aim was to assess the prognostic significance of the extent and anatomical site of pancreatic tissue necrosis in the first contrast-enhanced CT scan. The scans were obtained a mean of 2·9 days after the onset of symptoms. The pancreatic head was affected in 107 patients, the body in 119 and the tail in 138. Pancreatic tissue necrosis, when divided into four groups according to anatomical site, correlated with overall clinical outcome. The anatomical site of necrosis was clearly better than its crude extent in predicting the risk of complications. For patients with necrosis in the head of the pancreas, the outcome was as severe as when the entire pancreas was affected. In contrast, for patients with necrosis only in the distal part of the pancreas, the outcome was favourable with few complications. The exact site of pancreatic tissue necrosis should be known when early contrast-enhanced CT is used in prognostic scoring.
Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma
Authors: Kwok S P Y , Lau W Y , Leung K L , Liew C T , Li A K C 
Published: March 2007

Abstract
The distal resection margin measured in situ at operation, on the fresh specimen and on the fixed specimen was analysed prospectively in 55 consecutive patients undergoing anterior resection for carcinoma of the rectum. There was obvious contraction in length from the operative margin to the specimen margin and to the fixed margin. As measured by contraction coefficients, contraction was greater in more proximal tumours than in distal ones. Eight of 55 patients had microscopic intramural spread in the fixed distal margin and the maximum spread was 12 mm. Taking contraction of the fixed margin into account, the extrapolated microscopic spread in the operative margin ranged from 0 to 47 mm.
Iron status following trauma, excluding burns
Authors: Walsh D S , Pattanapanyasat K , Lamchiagdhase P , Siritongtaworn P , Thavichaigarn P , Jiarakul N , Chuntrasakul C , Komoltri C , Dheeradhada C , Pearce F C , Wiesmann W P , Webster H K 
Published: March 2007

Abstract
Serum concentration of iron, transferrin saturation and total iron binding capacity (TIBC) were measured on days 1, 2, 3, 5, 7, 10 and 13 in 36 Thai patients with trauma (burns excluded) to determine temporal changes in iron metabolism. Throughout the study profound hypo-ferraemia was observed in association with decreased transferrin saturation. TIBC, in contrast, did not differ significantly from that in controls. These findings confirm previous reports which describe altered iron metabolism in association with an adverse event, a response known as ‘stress hypoferraemia’, and extends these observations to non-burned patients with trauma. The degree of hypoferraemia in patients in this study was not related to sepsis, Injury Severity Score, volume of blood transfused or surgery, suggesting that hypoferraemia following trauma is an independent event. The recognition of rapid and prolonged iron sequestration provides insight into the clinical condition of patients with trauma.
Pathological evidence in support of total mesorectal excision in the management of rectal cancer
Authors: Reynolds J V , Joyce W P , Dolan J , Sheahan K , Hyland J M 
Published: March 2007

Abstract
Some 50 total mesorectal excision specimens were examined following rectal excision for cancer. Circumferential margin involvement was rare, but mesorectal tumour deposits were present in 17 of 44 patients with pT3 tumours, and 23 of 44 had mesorectal nodal involvement. No patient with a pT2 tumour had mesorectal involvement. Failure to excise the mesorectum completely has the potential to leave gross or microscopic residual disease that may in theory predispose to local failure. Total mesorectal excision is necessary to avoid incomplete pathological evaluation of the mesorectum and understaging of rectal cancer.