bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery
Authors: Fung A , Rayter Z , Fisher C , King D M , Trott P 
Published: March 2007

Abstract
Microdochectomy has been the routine management for single-duct nipple discharge. Our review of 176 consecutive patients surgically treated between 1975 and 1988 revealed eight patients with in situ carcinomas and seven with infiltrative carcinomas. Seventeen patients had multiple papillomas, two had atypical hyperplasia and two had atypical epitheliosis. Case selection for surgery has recently been advocated. In our study, nipple discharge cytology was helpful in 67 per cent of cases with underlying malignant pathology. Mammography was found to be unreliable, alerting suspicion in only two of 15 cases.
Direct measurement of collagenase in colonic anastomosis
Authors: Chowcat N L , Savage F J , Lewin M R , Boulos P B 
Published: March 2007

Abstract
Collagenase has been implicated in colonic anastomotic dehiscence but the enzyme has not previously been specifically measured in colonic healing. A 72 h tissue culture method for colonic tissue and a radio chemical assay for collagenase were adapted to measure the enzyme in healing rabbit colon, with specificity of the assay confirmed by sodium dodecylsulphate polyacrylamide gel electrophoresis. Normal and postoperative colon secreted collagenase, predominantly in a latent form, in the first 24 h of culture. Total activity reached a plateau after 48 and 72 h in culture, when 50–70 per cent of the enzyme was in an active form. At these times in culture, activity was significantly higher than after 24 h (P &lt; 0.001). One day after anastomosis the total amount of collagenase secreted in culture was higher than normal but the increase did not achieve significance. Three days after anastomosis the colon secreted more collagenase than explants from 1 day postoperative tissue (P &lt; 0.002). The proportion of active enzyme in the first 24 h in culture was also increased. Since active collagenase can be measured in culture medium from both normal and postoperative colon, the tissue may be secreting plasminogen activator which allows plasmin to activate the enzyme. The increase in collagenase after operation coincided with a decrease in collagen concentration in the colon wall, measured by hydroxyproline. This supports previous suggestions that collagenase contributes to anastomotic dehiscence. However, the findings must be interpreted with caution as the variance of the results was shown to be predominantly due to time in culture, suggesting this could be a bigger influence than the operation itself. In addition, our previously reported immunohistochemical study of this system indicated that collagenase only occurred in a localized region, restricted to the everted portion of the anastomosis, with the activity being tightly controlled by its inhibitor, tissue inhibitor of metalloproteinases.
Epidermal growth factor receptor expression in colorectal cancer
Authors: Steele R J C , Kelly P , Ellul B , Eremin O 
Published: March 2007

Abstract
Epidermal growth factor (EGF) receptor expression was estimated in 50 invasive human colorectal cancers using immunohistochemistry and the degree of expression was quantified from integrated optical density measurements on the stained sections. All tumours stained positively, but Dukes' C tumours exhibited significantly higher levels of receptor than either Dukes' A or B tumours. In addition, histologically high grade cancers expressed receptors more strongly than those of low grade. It is concluded that a high EGF receptor concentration is associated with poor prognostic factors in colorectal malignancy.
Effect of vaginal delivery on the pelvic floor: A 5-year follow-up
Authors: Snooks S J , Swash M , Mathers S E , Henry M M 
Published: March 2007

Abstract
We have studied the pelvic floor musculature and its innervation in 14 of 24 (58 per cent) multiparous women who had been recruited into a study of the effect of childbirth on the pelvic floor as part of a prospective investigation that began in 1983. These 24 women had all delivered by the vaginal route without forceps assistance. Five of the 14 had developed clinical symptoms of stress incontinence 5 years later; two of them had had a further uncomplicated vaginal delivery during this time. There was manometric and neurophysiological evidence of weakness because of partial denervation of the pelvic floor striated sphincter musculature, with pudendal neuropathy, which was more marked in those women with incontinence. These findings provide direct evidence for the hypothesis that pudendal neuropathy due to vaginal delivery persists and may worsen with time.
Primary papillary carcinoma of a thyroglossal duct cyst: Report of a case and literature review
Authors: Weiss S D , Orlich C C 
Published: March 2007

Abstract
Thyroglossal duct cysts are the most common anomaly in thyroid development. They are twice as frequent as branchial cleft abnormalities and, in children, are second only to enlarged cervical lymph nodes as the cause of neck mass. Generally, duct cysts are benign, but 1 per cent of cases may be malignant. From the world literature, 114 cases of malignant thyroglossal cysts were available for review. With the addition of our own case, we discuss 115 instances of duct cysts. The different types of neoplasia described included thyroid papillary carcinoma in 81·7 per cent, mixed papillary-follicular carcinoma in 6·9 per cent, squamous cell carcinoma in 5·2 per cent, follicular and adenocarcinoma in 1·7 per cent each, and malignant struma, epidermoid carcinoma and anaplastic carcinoma in 0·9 per cent each. Of the 115 cases surveyed, 35 thyroid glands were examined microscopically; of these, four (11·4 per cent) contained malignant foci. Whether these are primary malignancies of the thyroglossal duct cysts or metastases is discussed.
Surgical strategies in the treatment of pancreatic necrosis and infection
Authors: D'Egidio A , Schein M 
Published: March 2007

Abstract
Controversy still surrounds the management of necrotic and septic complications of acute pancreatitis. A review of the literature of the past decade dealing with the surgical treatment of pancreatic necrosis, pancreatic abscess and infected pancreatic necrosis has been undertaken. Three main patterns of management could be identified: (1) ‘conventional treatment’, consisting of pancreatic resection or necrosectomy with drainage; (2) ‘local lavage’, consisting of necrosectomy followed by regional lavage; and (3) ‘open management’, with resection or necrosectomy followed by planned multiple re-explorations. From this review it appears that local lavage and open management offer better survival prospects than conventional treatment. Open abdomen techniques, however, are associated with an increased risk of complications, such as colonic necrosis, intestinal fistula, and intra-abdominal bleeding. Excellent results can be achieved in specialized centres with any of the three methods, provided adequate debridement and prompt reoperations are undertaken if the septic state persists.
Conventional Versus laparoscopic cholecystectomy and the randomized controlled trial
Authors: Neugebauer E , Troidl H , Spangenberger W , Dietrich A , Lefering R 
Published: March 2007

Abstract
We considered using a randomized trial to assess the value of laparoscopic cholecystectomy in the treatment of symptomatic gallstones. The pros and cons for the timing of such a trial were in favour of not beginning the trial until surgeons learned to use the new procedure safely and effectively, and until key endpoints and outcome indices could be identified and assessed using valid measures. Instead an observational study was implemented to monitor the learning curve of surgeons as they mastered the laparoscopic equipment and procedures, and to assess the responses of the patients to the procedure. In the first 100 patients, the procedure proved to be as safe and feasible to use as conventional surgery, and there were strong benefits in terms of quicker recovery of the patients with less pain, discomfort, and a reduced length of hospital stay. The responses of the surgeons and the patients to the new procedure now place ethical constraints on the planning of a randomized controlled trial. Currently, comprehensive surveillance and monitoring of laparoscopic cholecystectomy is the only realistic method with which to assess the impact of this new technology in our clinic.
Population-based study of surgery in juvenile onset ulcerative colitis
Authors: Sedgwick D M , Barton J R , Hamer-Hodges D W , Nixon S J , Ferguson A 
Published: March 2007

Abstract
A geographically based cohort of 37 children with ulcerative colitis has been derived by sampling from Scottish Hospital In-patient Statistics. Surgical histories were examined and analysed by actuarial methods, and the major operations performed were compared with operations for ulcerative colitis in the Lothians' Surgical Audit. Fourteen of the 37 patients had a total of 26 operations (15 major, 11 minor). Sixteen per cent had major surgery within 5 years of onset of symptoms, and the types of operation were similar to those recorded in Lothians' Surgical Audit. Operation rate was significantly lower than that for a parallel cohort of patients with Crohn's disease. With a mean follow-up of 7.4 years, seven (19 per cent) patients have a permanent stoma and there has been one death.
Natural history of indeterminate colitis
Authors: Wells A D , McMillan I , Price A B , Ritchie J K , Nicholls R J 
Published: March 2007

Abstract
The long-term outcome of patients with a pathological diagnosis of indeterminate colitis on a colectomy specimen was investigated. The case records of 46 such patients operated on for inflammatory bowel disease between 1960 and 1983 were reviewed. Using the preoperative clinical information, pathological and radiological reports, it was possible to divide the patients into three groups: group 1, probable Crohn's disease (19 cases); group 2, probable ulcerative colitis (11 cases); and group 3, indeterminate colitis (16 cases). The patients were followed for a minimum of 2.5 years (median 10, range 2·5–28 years). During this period the probable diagnosis changed in five cases only. One patient in group 1 (Crohn's disease) was subsequently considered to have ulcerative colitis (group 2). The other four patients were all in group 3. Three were reclassified as ulcerative colitis and the fourth as Crohn's disease on the finding of a single granuloma in a rectal biopsy. No case in group 3 required subsequent small bowel surgery. These data suggest that patients continuing with a diagnosis of indeterminate colitis in spite of careful preoperative and postoperative assessment are unlikely to show features of Crohn's disease in the long term. This may be important when considering a subsequent restorative proctectomy.
Outcome after emergency surgery for cancer of the large intestine
Authors: Runkel N S , Schlag P , Schwarz V , Herfarth C 
Published: March 2007

Abstract
The data for 77 patients with colorectal cancer who underwent emergency surgery for acute intestinal obstruction (57 patients) or perforation (20 patients) within 24 h of admission were evaluated. The patients were older and had more advanced disease than patients undergoing elective surgery for colorectal cancer. Emergency surgery for carcinoma of the right colon consisted of primary resection in 95 per cent of cases and was followed by a 28 per cent mortality rate. Perforated tumours of the left colon and rectum were managed by primary resection in 82 per cent of cases with a 22 per cent mortality rate. In contrast, obstructing tumours of the left colon and rectum were treated by primary resection in 38 per cent of cases with a 6 per cent mortality rate, and by primary decompression in 62 per cent of cases with a 25 per cent mortality rate. The overall postoperative mortality rate was 23 per cent and increased with advanced tumour disease, perforation and peritonitis. Cardiac decompensation and intraabdominal sepsis were the major causes of death. Although the long-term survival rate following emergency surgery was worse than after elective surgery, improvements in outcome should be achieved by better management of the initial emergency situation.
Reoperations for late complications following abdominal aortic operation
Authors: Haiart D C , Callam M J , Murie J A , Ruckley C V , Jenkins A Mcl 
Published: March 2007

Abstract
Fifty patients were identified who, following abdominal aortic operation, developed late complications affecting the vascular graft or endarterectomy and who underwent their first reoperation between 1979 and 1989. Thrombosis was the commonest complication affecting 28 (56 per cent) patients, followed by false aneurysm in 11 (22 per cent), enteric fistula in nine (18 per cent) and graft infection in two (4 per cent). The 30-day mortality rate for reoperation was 8 per cent; longer follow-up revealed mortality rates of 22, 50 and 63 per cent at 1, 3 and 5 years respectively. Thirty-four complications required reoperation within 5 years of the original surgery. Reoperation was needed for 35 patients whose original pathology was occlusive disease and for 15 whose original pathology was aneurysm. The nature of the complication was related to initial pathology; thrombosis was far commoner in those with occlusive disease, and enteric fistula and false aneurysm were commoner in those with aneurysmal disease.
Where there is no anaesthetist…
Authors: Leppäniemi A K 
Published: March 2007

Abstract
In an unselected series of 254 operations representing a wide range of surgical, obstetric and gynaecological procedures carried out on the small Pacific island of Tuvalu, the majority (85 per cent) involved the lower half of the body. In all cases but one anaesthesia was administered by a non-specialist. In operations below the level of the diaphragm epidural anaesthesia was usually used with a success rate of 96 per cent. In the upper half of the body ketamine was used where local or regional block was insufficient. Only one operation was performed under general inhalation anaesthesia. The overall postoperative mortality rate was 0·4 per cent and the morbidity rate was 13 per cent. Only two minor complications were attributed to the anaesthetic method used. In situations where anaesthetists are not available, epidural and ketamine anaesthesia in the hands of non-specialists are safe and practical options to general inhalation anaesthesia and are appropriate for most surgical procedures.
Surgical management of primary hyperhidrosis
Authors: Moran K T , Brady M P 
Published: March 2007

Abstract
Primary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. Iontophoresis may provide relief especially in patients with plantar or palmar involvement. In severe cases operative intervention is necessary. Excision of sweat glands is successful in patients with axillary hyperhidrosis but the role of suction-assisted removal of axillary sweat glands remains to be determined. Sympathectomy remains the standard by which other treatments must be judged. For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non-operative intervention is relieved by lumbar sympathectomy.
Biliary bile acid profiles in familial adenomatous polyposis
Authors: Spigelman A D , Owen R W , Hill M J , Phillips R K S 
Published: March 2007

Abstract
Patients with familial adenomatous polyposis have an excess risk for adenomas and cancers of the upper and lower gastrointestinal tract. In the upper intestine these lesions occur mainly around the ampulla of Vater and they parallel mucosal exposure to bile. In view of this finding and of evidence that bile acids play a role in colorectal carcinogenesis, biliary bile acid profiles were determined in 29 patients with familial adenomatous polyposis (12 before colectomy, 17 after colectomy) and in 28 patients without familial adenomatous polyposis (all with colons in situ). Patients with familial adenomatous polyposis had a higher total biliary bile acid concentration than the others. The bile of patients with polyposis had a greater proportion of chenodeoxycholic acid and a lower proportion of deoxycholic acid than did the bile of patients without polyposis. The ratio of chenodeoxycholic acid and its metabolite lithocholic acid to cholic acid and its metabolite deoxycholic acid, which is related to subsequent bile acid profiles in the colon, was higher in patients with polyposis. Because bile acids influence cellular proliferation, these findings may be of importance with respect to intestinal adenoma and cancer growth.
Tumour necrosis factor increases hepatic cell mass
Authors: Mealy K , Wilmore D W 
Published: March 2007

Abstract
The effect of tumour necrosis factor (TNF) on hepatic cellularity was investigated in male Wistar rats maintained on total parenteral nutrition. Twenty-eight rats were infused with TNF (2 × 105 units TNF-α kg−1 24 h−1) or saline (controls) for 6 days. Wet and dry liver weights and nitrogen content were significantly increased by TNF (P&lt;0·001), indicating an increase in liver mass. A further 81 rats were infused with TNF (2 or 4 × 105 units kg−1 24 h−1) or saline over 1, 3 and 6 days. Total liver DNA and protein content and counts of hepatocyte mitosis were determined. Liver DNA and protein increased with dose of TNF and time (P&lt;0·001), suggesting that TNF increased hepatic cellularity. Histological examination demonstrated no significant inflammatory infiltrate to account for the increased cell mass. However, the number of hepatocyte mitoses increased with dose of TNF and time (P&lt;0·05), indicating that the increase in liver cellularity was due to increased hepatocyte cell number. TNF-induced hepatic hyperplasia appears to be an additional feature of the integrated host response to injury and infection.
Comparison of a single layer continuous hand-sewn method and circular stapling in 580 oesophageal anastomoses
Authors: Fok M , Ah-Chong A K , Cheng S W K , Wong J 
Published: March 2007

Abstract
A total of 611 patients with carcinoma of the oesophagus or gastric cardia were operated on between July 1982 and December 1989. Resection was performed in 491 patients (one-stage, 483; two-stage, eight), bypass operation in 97, and 23 had exploration alone. The anastomoses of 580 patients with one-stage resection and bypass operations were evaluated. Hand-sewn anastomosis using a single layer of continuous absorbable monofilament suture was performed in 304 patients (221 resections and 83 bypasses). A stapled anastomosis was performed on 276 patients (262 resections and 14 bypasses). Following resection, there were 11 (5 per cent) anastomotic leaks in the hand-sewn group and ten (3·8 per cent) in the stapled anastomosis group (P = 0·69). Excluding anastomotic leaks, hospital mortality and anastomotic recurrence, stricture occurred in 18 of 172 hand-sewn anastomoses (10·5 per cent) and in 57 of 195 stapled anastomoses (29·2 per cent) (P &lt; 0·001). In patients who had bypass operations there were 12 anastomotic leaks, ten in the hand-sewn group (12·0 per cent) and two in the stapled anastomosis group (14·3 per cent). Only two of the discharged patients with bypass developed anastomotic strictures, a low incidence probably because of short survival. In addition, there were 245 subsidiary anastomoses made in the abdomen by the hand-sewn method as part of the reconstructive procedure, and there was one leak. The results of this non-randomized study suggest that hand-sewn anastomosis using a single layer continuous technique for the oesophagus is as safe as the use of circular staplers; hand-sewn anastomosis is less likely to become stenotic.
Confirmation of endosonographic detection of external anal sphincter defects by simultaneous electromyographic mapping
Authors: Burnett S J D , Speakman C T M , Kamm M A , Bartram C I 
Published: March 2007

Abstract
Anal endosonography was performed in 13 consecutive patients with post-traumatic faecal incontinence. Thirteen acoustic defects in the external anal sphincter (two hyperechoic, four of mixed echogenicity and seven hypoechoic) were analysed electromyographically by locating under ultrasound guidance the tip of a concentric needle within the defect. The electromyographic activity in this zone was compared with ultrasonically normal muscle. Eleven of 13 sonographic defects showed no electrical activity on electromyography, there was one technical electromyography failure, and one defect was too deep to be reached by the electromyography needle. The electromyographic response was normal in each case within ultrasonically normal muscle. Anal endosonography is recommended as the initial investigation to locate defects, which may be confirmed electromyographically thereby limiting the number of painful needle insertions required for complete mapping of the external anal sphincter.
Long-term results of choledochoduodenostomy in the treatment of choledocholithiasis: Assessment of 225 cases
Authors: Parrilla P , Ramirez P , Bueno F Sanchez , Perez J M , Candel M F , Muelas M S , Robles R 
Published: March 2007

Abstract
During a 10-year period 2610 patients were operated on for biliary lithiasis; in 225 (8·6 per cent) cases the operation concluded with a choledochoduodenostomy. The commonest preoperative diagnosis (62·2 per cent) in these 225 patients was choledocholithiasis; 30 patients had previously had a cholecystectomy. After choledochoduodenostomy, 4·0 per cent of patients had an intra-abdominal complication; six patients developed an intra-abdominal abscess and three developed an external biliary fistula. Four patients (1·8 per cent) died, three from pulmonary complications and one from a biliary fistula. After a mean follow-up period of 4·6 years, 71·5 per cent of patients were asymptomatic. The remainder suffered from dyspepsia (15·1 per cent), colicky pain (8·7 per cent) or episodes of cholangitis (4·7 per cent). Endoscopy in the symptomatic patients allowed the following conclusions: (a) no patient with dyspepsia had a problem at the anastomosis; (b) 27 per cent of those with colic had anastomotic stenosis or the sump syndrome; and (c) all patients with cholangitis had anastomotic stenosis and residual calculi.