bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operative common bile duct imaging by operative cholangiography and flexible choledochoscopy
Authors: Menzies D , Motson R W 
Published: March 2007

Abstract
A consecutive series of 108 common bile duct (CBD) explorations was studied to examine the efficacy of routine operative cholangiography and flexible choledochoscopy in the identification of choledocholithiasis. CBD exploration was performed according to the findings of routine operative cholangiography. Nine negative explorations were performed, only one of which would have been avoided had selective cholangiography been employed. Eight patients had unsuspected choledocholithiasis that would have been missed if selective operative cholangiography had been used. Flexible choledochoscopy identified CBD stones on 97 occasions; no additional retained stones were found on subsequent T tube cholangiography. In two cases stones were seen but could not be removed; immediate identification allowed planning for early removal. Flexible choledochoscopy is the most eflective method of CBD exploration and should be used in all patients with suspected choledocholithiasis.
Laparoscopic versus open appendicectomy: A prospective evaluation
Authors: McAnena O J , Austin O , O'Connell P R , Hederman W P , Gorey T F , Fitzpatrick J 
Published: March 2007

Abstract
A prospective evaluation of laparoscopic surgery for acute appendicitis over a 6-month period is reported. Sixty-five patients with signs and symptoms of appendicitis necessitating surgery were assigned to open (n = 36) or laparoscopic (n = 29) appendicectomy. Thirty-seven patients were female (22 open) and 28 were male (14 open). The median age was 24 (range 14–64) years for open appendicectomy and 18 (range 14–60) years for the laparoscopic procedure. The mean postoperative stay for open operation was 4.8 (range 1–21) days and for the laparoscopic route 2.2 (range 1–11) days (P &lt; 0.05). Inflammation was confirmed histologically in 72 per cent of the open cases and in 74 per cent of the laparoscopic cases (P not significant). The wound infection rate was 11 per cent (n = 4) for open and 4 per cent (n = 1) for laparoscopic appendicectomy (P &lt; 0.05). The median anaesthesia time was 52 (range 15–90) min for open appendicectomy and 48 (range 20–120) min for laparoscopic surgery (P not significant). After open appendicectomy patients had a median of 5 (range 2–12) intramuscular injections of analgesia compared with a median of 1 (range 0–5) in the laparoscopic group (P &lt; 0.05). Two laparoscopic operations were converted to an open procedure. The results suggest that emergency laparoscopic appendicectoiny should be explored further as an alternative to open surgeŕy for acute appendicitis.
Decreased sensitivity of muscarinic but not 5-hydroxytryptamine receptors of the internal anal sphincter in neurogenic faecal incontinence
Authors: Speakman C T M , Hoyle C H V , Kamm M A , Henry M M , Nicholls R J , Burnstock G 
Published: March 2007

Abstract
Previous studies of the internal anal sphincter in patients with neurogenic faecal incontinence have indicated an abnormality of the adrenergic innervation, but little is known about the responsiveness of other receptors in the internal anal sphincter in this condition. In this study the in vitro sensitivity to carbachol and 5-hydroxytryptamine (5-HT) of muscle strips from patients with neurogenic incontinence (n = 6 and n = 7) and from control patients (n = 9 and n = 10) was examined. Preparations of internal anal sphincter from patients with incontinence were less sensitive to the relaxant actions of carbachol than preparations from the control group. The pD2 value for carbachol (i.e. the negative logarithm of the concentration f o r half-maximal response) was signficantly greater in the controls than in the incontinent group (mean(s.e.m.) 6.03(0.15) versus 5.43(0.24), P &lt; 0.05). There was no significant difference in the contractile responses to 5-HT, which had pD2 values of 6.93(0.13) and 6.63(0.27) for the control and incontinent groups respectively. The unaffected state of the 5-HT receptor and the subsensitivity of the muscarinic receptor are discussed in relation to intrinsic neural control of the internal anal sphincter in neurogenic, faecal incontinence.
Screening for colorectal carcinoma: An analysis of the sensitivity of Haemoccult
Authors: Thomas W M , Pye G , Hardcastle J D , Walker A R 
Published: March 2007

Abstract
The sensitivity of Haemoccult for asymptomatic colorectal carcinoma has been estimated in a large randomized controlled trial of mass population screening, with a minimum follow-up of 2 years. A total of 111 cancers were diagnosed in those who completed the screening tests; of these, 36 appear to have been missed by Haemoccult and 75 were detected by the test, giving an overall sensitivity of 67.6 per cent. Haemoccult was shown to be significantly more sensitive for carcinoma of the sigmoid and descending colon than for rectal or right-sided cancers (81 versus 45 and 47 per cent, respectively). The sensitivity was higher when tests were completed over 6 rather than 3 days (74 versus 65 per cent), but this diference was not statistically significant. There was no evidence for a detrimental effect on tumour stage of a false-negative Haemoccult test; indeed, a higher proportion of the interval cancers were Dukes' A tumours than cancers in the control group.
Timing and method of reversal of Hartmann's procedure
Authors: Pearce N W , Scott S D , Karran S J 
Published: March 2007

Abstract
The outcome of 145 patients undergoing Hartmann's resection between 1973 and 1989 has been reviewed. The mortality rate of the primary procedure was 8 per cent. Eighty patients proceeded to reanastomosis. Multifactorial analysis of these patients was undertaken to determine the risk involved. The interval between the primary and secondary procedures was found to be the most important factor. Six of 12 patients had clinical evidence of a leak when this interval was &lt;3 months, compared with seven of 28 for 3–6 months, and none of 40 when the second operation was delayed for &gt;6 months. All deaths (three patients) and clinical septicaemia (four) occurred in the two ‘early’ groups. All colovaginal fistulae (three patients) and strictures (three) were associated with stapled anastomoses. No association was found between the complication rate following reanastomosis and the initial pathology or grade of surgeon undertaking the secondary operation.
Surgical treatment of hidradenitis suppurativa
Authors: Banerjee A K 
Published: March 2007

Abstract
The management of hidradenitis suppurativa is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience and low recurrence - but greater awareness of the strengths and weaknesses of existing methods should lead to improved management. Good reports of the relative cure rates of the different surgical options are scarce and controlled trials non-existent, but existing evidence is reviewed critically and summarized. The operation of choice in most instances is wide local excision and healing by secondary intention.
Perforated duodenal diverticulum
Authors: Duarte B , Nagy K K , Cintron J 
Published: March 2007

Abstract
Duodenal diverticula are present in up to 20 per cent of the population but few patients require surgery for acute complications. Perforation is the rarest of these complications; only 101 affected patients have been reported in the world literature. These reports of perforated duodenal diverticulum are reviewed and strategies for the diagnosis and management of this unusual condition are discussed.
Anatomy and function of the anal longitudinal muscle
Authors: Lunniss P J , Phillips R K S 
Published: March 2007

Abstract
The longitudinal muscle in the intersphincteric space has received little attention despite an explosion of interest in anorectal physiology in the past decade. Its anatomy is contested and its function unknown. Speculation, however, gives it a role as a skeleton supporting and binding the rest of the internal and external sphincter complex together, as an aid during defaecation by everting the anus, as a support to the haemorrhoidal cushions, and as a determining factor in the ramification of sepsis.
Selection for screening for familial aortic aneurysms
Authors: Adamson J , Powell J T , Greenhalgh R M 
Published: March 2007

Abstract
The reported familial clustering of abdominal aortic aneurysm (AAA) indicates the possible rewards of family-based screening programmes with respect both to the number of asymptomatic aneurysms detected and to identifying associated genes. Ultrasonographic screening of 28 families (25 brothers and 28 sisters) was carried out together with collecting a history and a blood sample for analysis of the cholesterol level and genetic markers. Among the screened siblings six (11 per cent), all &gt;60 years old, had an AAA ⩾3.0 cm in diameter. A further 11 siblings (21 per cent), six of whom were &lt; 60 years old, had a wide (2.5–2.9 cm) aorta. The presence of an aneurysmal or wide aorta was significantly associated with smoking (P = 0.027), male sex (P = 0.008) and a proband age of &lt; 60 years (P = 0.031). Polymorphic genetic markers for type III collagen and haptoglobin were not informative in these families. These results indicate that the eficiency of screening siblings of patients with AAA could be improved by limiting it to brothers with a smoking history and/or siblings of younger patients. The familial component appears to be greatest in these younger patients.
Randomized trial of loop ileostomy in restorative proctocolectomy
Authors: Grobler S P , Hosie K B , Keighley M R B 
Published: March 2007

Abstract
A randomized controlled trial was performed to assess the role of loop ileostomy in totally stapled restorative proctocolectomy. Entry criteria included all patients who were not on corticosteroids in whom on-table testing revealed a watertight pouch with intact ileoanal anastomosis. Of 59 patients undergoing restorative proctocolectomy over 36 months, 45 were eligible and were randomized to loop ileostomy (n = 23) or no ileostomy (n = 22). The age and diagnosis of the groups were similar. There were no deaths; two ileoanal anastomotic leaks occurred, one in each group. Ileoanal stenosis occurred in five patients with and one without an ileostomy. The incidences of wound and pelvic sepsis, bowel obstruction and pouchitis were similar. Twelve patients (52 per cent) developed ileostomy-related complications. The median total hospital stay was 23 (range 13–75) days with ileostomy and 13 (range 7–119) days without (P &lt; 0.001). This study indicates that there is a low risk of pelvic sepsis which is not increased by avoiding a protective ileostomy. Loop ileostomy was associated with a high incidence of complications.
Reduction of thrombus formation in vivo using a thrombolytic agent targeted at damaged endothelial cells
Authors: Underwood M J , Pringle S , De Bono D P 
Published: March 2007

Abstract
Endothelial damage in saphenous vein harvested before coronary artery and peripheral vascular surgery has been well documented. Autogenous saphenous vein grafts are subject to early thrombotic occlusion, a process that is related to injury of this endothelial monolayer. A monoclonal antibody that binds to areas of endothelial damage (P14G11) and a non-specific immunoglobulin G (IgG) have been linked to urokinase. These conjugates were investigated in vivo using a rat vena cava model. The P14G11–urokinase conjugate significantly reduced thrombus formation compared with controls and non-conjugated urokinase (P &lt; 0.02). No reduction in thrombus formation was seen with the IgG-urokinase conjugate. This shows that thrombus formation after endothelial damage in an in vivo model can be reduced with a targeted thrombolytic agent. Conjugates such as this may have a role in preventing early thrombotic occlusion in vein grafts.
Recombinant basic fibroblast growth factor in red blood cell ghosts accelerates incisional wound healing
Authors: Slavin J , Hunt J A , Nash J R , Williams D F , Kingsnorth A N 
Published: March 2007

Abstract
The pharmacological manipulation of wound healing with locally applied growth factors is now a practical possibility. The effect of topical applications of recombinant basic fibroblast growth factor (bFGF) on the strength and cellularity of healing incisional rat skin wounds was investigated. Applications of bFGF in a simple vector (either a collagen suspension or saline) were not associated with any positive effects on wound breaking load at 7 days after injury in comparison with vector-treated control wounds; at the highest dose of 50 μg per wound, breaking loads were significantly decreased from a mean(s.e.m.) of 287(22) g/cm2 in controls to 201(23) g/cm2 (P &lt; 0.005). Increasing doses of applied peptide were paralleled by increasing wound cellularity. Delay of bFGF release at the site of application was achieved by encapsulation into red blood cell ghosts. Wounds treated with bFGF in such ghosts were 50 per cent stronger than paired control wounds (388(27) versus 256(28) g/cm2, P &lt; 0.002) 7 days after injury. Treated wounds were significantly more cellular at 4 days than paired control wounds. Topical applications of bFGF applied at the time of injury exert a positive effect on incisional wound strength only when a vector that delays release is used.
Smoking predisposes to parotid adenolymphoma
Authors: Cadier M , Watkin G , Hobsley M 
Published: March 2007

Abstract
Of 574 patients with previously untreated, unremarkable parotid lumps, 194 proved to have pleomorphic adenomas and 73 adenolymphomas. ABO blood group details were available in 59 and 85 per cent of patients respectively. Smoking details were available in 84 per cent of a randomly chosen 46 per cent subgroup of patients with pleomorphic adenomas and in 86 per cent of all those with adenolymphomas. The incidences of smoking and of the ABO blood groups in these two diagnoses were compared with standard sources. There was no evidence that either histological diagnosis of parotid tumours was linked to an abnormal pattern of ABO blood groups. However, there was a much greater incidence of smoking among the adenolymphoma than in the pleomorphic adenoma group: only one of 63 patients with adenolymphoma as opposed to 31 of 75 with pleomorphic adenoma had never smoked, while the mean number of cigarettes smoked by each patient with an adenolymphoma was estimated to be 300 000 as opposed to 80 000 for those with pleomorphic adenoma.
Surgery for primary hyperparathyroidism performed under local anaesthesia
Authors: Bergenfelz A , Algotsson L , Ahrén B 
Published: March 2007

Abstract
Patients with primary hyperparathyroidism are often elderly with cardiovascular disease and in some an operation might be hazardous owing to anaesthetic complications. A technique for operation for primary hyperparathyroidism under local anaesthesia is described. The method uses a unilateral approach. Seventeen consecutive patients operated on under local anaesthesia were compared with a group of 15 patients undergoing surgery under general anaesthesia. Normocalcaemia was achieved in 14 patients in each group. There was no difference in the extent of pain or the overall well-being between the two groups as determined by a visual analogue scale. Patients receiving local anaesthesia, however, experienced significantly less nausea after operation (P &lt; 0.01). There was more fluctuation in blood pressure and heart rate in the general anaesthesia group compared with the other group. Surgery for primary hyperparathyroidism can be performed safely under local anaesthesia, and could be offered to patients if general anaesthesia were not suitable or involved an increased perioperative risk. It should not be recommended for routine use in patients who are fit for general anaesthesia.
Surgical resection for stage I cancer of the oesophagus and cardia
Authors: Moghissi K 
Published: March 2007

Abstract
A study was carried out to establish the long-term survival of patients with stage I carcinoma of the oesophagus and cardia, and to assess the influence of various factors on the 5-year survival rate. The study, which was partly prospective and partly retrospective, involved 60 patients with early (stage I) carcinoma of the oesophagus or cardia from a total of 811 consecutive patients with such carcinomas who were referred to one regional centre over a 15-year period, 425 of whom underwent resection. Survival at 5 years was taken as the main measure of outcome. Forty-two patients (70 per cent) were alive at 5 years. None of the factors studied (sex, age, site or histological type of tumour) had a significant effect on outcome.
Oesophageal reflex responses: Abnormalities of the enteric nervous system in patients with oesophageal symptoms
Authors: O'Hanrahan T , Bancewicz J , Thompson D , Marples M , Williams D 
Published: March 2007

Abstract
An intraluminal balloon was used to study the peristaltic reflex, which is mediated by the intrinsic nerves of the oesophagus. Serial balloon distension was performed in nine asymptomatic volunteers and 133 patients with oesophageal symptoms. Eight of the volunteers had a normal response with proximal stimulation and distal inhibition of motility. Only 42 patients (31.6 per cent) had a normal response. The commonest abnormal response (39.1 per cent) was some form of failure of the distal inhibitory reflex. Other patterns of abnormality were an unresponsive oesophagus (15.8 per cent) with no motility change during balloon inflation, or spasm (13.5 per cent) proximal to the balloon. These alterations of secondary peristaltic activity suggest that there are abnormalities of the intrinsic (enteric) nerves of the oesophagus. Different abnormalities were found in patients with similar symptoms. Awareness of this difference might allow a more rational approach to treatment. This hypothesis was tested in a small pilot study treating functional dysphagia with cisapride. Three of nine patients had marked symptomatic improvement within 4 weeks and all three had an unresponsive oesophagus. The remaining six patients, who had failure of distal inhibition or a normal response, did not improve.
Adequacy of paracardial dissection in subtotal versus total gastrectomy
Authors: Hüscher C , Chiodini S , Freni V , Recher A , Torri F , Bozzetti F 
Published: March 2007

Abstract
Right and left paracardial dissection represents an obligatory step in gastrectomy for gastric cancer of the lower half of the stomach because a second-level lymphadenectomy is part of the radical surgery for malignancy at this site. Whereas right and left paracardial dissection is easily accomplished during total gastrectomy, there is doubt as to whether subtotal gastrectomy achieves the same radical clearance of these groups of lymph nodes. This study therefore compared the number of lymph nodes dissected and the frequency of metastases in these compartments in 14 patients undergoing total gastrectomy and 22 submitted to subtotal gastrectomy. The mean number of lymph nodes dissected in the right paracardial compartment was 7.1 per patient undergoing total gastrectomy and 6.7 per patient in subtotal gastrectomy (P = 0.7). The mean numbers of left paracardial lymph nodes dissected in total and subtotal gastrectomy were 3.4 and 4.1 per patient respectively (P = 0.3). These data show that the same degree of radical clearance can be achieved in these nodal compartments, irrespective of the extent of gastric resection.
Zinc-deficient diet impairs adaptive changes in the remaining intestine after massive small bowel resection in the rat
Authors: Tamada H , Nezu R , Matsuo Y , Takagi Y , Okada A , Imamura I 
Published: March 2007

Abstract
An investigation was conducted on the influence of the presence of zinc in an elemental diet on the mucosa of residual intestine after massive small bowel resection. A total of 34 male Sprague-Dawley rats were divided into five groups: control animals (n = 10) were killed after overnight fasting; a second group (n = 14) underwent massive small bowel resection preserving 10 cm of terminal ileum, and the third group (n = 10) underwent sham operation. Animals in the second and third groups were fed either a commercially available elemental diet or a zinc-deficient diet for 2 weeks; they were then killed. In animals receiving the zinc-deficient diet, a significant decrease (P &lt; 0.05) was noted in plasma zinc and total protein, and in mucosal wet weight (duodenum), thickness (duodenum and ileum), and protein (duodenum) and DNA (duodenum) content. Mucosal sucrase and maltase specific activities in the duodenum and ileum fell but diamine oxidase levels did not. These results suggest that zinc plays an important role in intestinal adaptation in the rat, and indicate that this trace element is essential for intestinal mucosal preservation in this animal.
Laparoscopy in developing countries in the management of patients with an acute abdomen
Authors: Ogbonna B C , Obekpa P O , Momoh J T , Obafunwa J O , Nwana E J C 
Published: March 2007

Abstract
Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultra-sonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P &lt; 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.
Endotoxin, septic shock and acute lung injury: Neutrophils, macrophages and inflammatory mediators
Authors: Welbourn C R B , Young Y 
Published: March 2007

Abstract
The treatment of septic shock remains a major problem in surgical practice. Current research on the pathogenesis of the sepsis syndrome focuses on the effects of the lipopolysaccharide constituents of bacterial endotoxin. Evidence suggests that endotoxin induces a whole-body inflammatory response that in turn mediates organ damage, eventually leading to multiorgan failure. The first organ in which failure is usually apparent is the lung, with the appearance of nonEndotoxin, septic shock and acute lung injury:-cardiogenic pulmonary oedema as part of the adult respiratory distress syndrome. Inflammatory cells involved in lung injury include neutrophils and macrophages, which release mediators such as elastase, oxygen radicals and cytokines. This review summarizes current experimental work on how endotoxin leads to lung injury, based on its effects in animals and patients. Present knowledge suggests that future treatment of septic shock might involve inhibiting the body's inflammatory response to endotoxin. Possible ways of doing this are discussed.
Synchronous aortic and gastrointestinal surgery
Authors: Brown T H , Kelly J F 
Published: March 2007

Abstract
The synchronous performance of aortic and gastrointestinal surgery may hold an increased risk of aortic graft infection. The experience of one surgeon who performed 32 such synchronous operations over a period of 11 years is reviewed. No graft infection occurred and it is concluded that such combined operations may be safer to perform than staged surgery in elderly patients.