bluuebunny/crossref_metadata_2025_split huggingface dataset:
Follicular carcinoma of the thyroid gland in Hong Kong Chinese
Authors: Lo C Y , Lorentz T G , Wan K Y 
Published: March 2007

Abstract
A total of 64 Chinese patients (eight men, 56 women) undergoing primary treatment for follicular thyroid cancer between 1961 and 1986 were studied retrospectively to report the local experience in treatment of this condition and to identify the risk factors for mortality. The minimum follow-up was 7 (median 14) years. The mean tumour size was 3·0 (range 0·1–11·0) cm. The majority of patients (91 per cent) underwent total or near-total thyroidectomy. Distant metastases were detected in ten patients at the time of initial diagnosis and in three during follow-up. Locoregional recurrence had developed in six patients at follow-up. There were 13 deaths, with a median survival of 45 months. The 5- and 10-year survival rates were 87 and 80 per cent respectively. Six risk factors for mortality were selected for multivariate analysis using logistic regression; the presence of distant metastasis was the only significant risk factor for survival.
Healing process of sutureless choledochojejunostomy in an experimental model
Authors: Ishizaki Y , Bandai Y , Shimomura K , Idezuki Y , Makuuchi M 
Published: March 2007

Abstract
The healing characteristics and morphological features of sutureless choledochojejunostomy were investigated in a rat experimental model. The common bile duct of 34 conditioned Wistar rats was exposed, divided transversely and a choledochojejunostomy constructed with only a vinyl chloride tube positioned between the common duct and jejunum. The animals were killed 4, 12 and 52 weeks after surgery. Cholangiographic evaluation of the anastomosis in all three groups showed wide openings with dilatation of the extrahepatic bile duct. Microscopic examination of the anastomosis showed hyperplastic changes of the bile duct epithelium. The epithelial defect was completely covered with proliferative epithelium 12 weeks after operation. At long-term follow-up of 52 weeks there were no biliary strictures after the sutureless technique. This surgical approach may be useful for patients in whom sutured anastomosis of the bile duct might lead to stricture, such as those with a normal thin-walled bile duct.
Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery
Authors: Rijna H , Borgstein P J , Meuwissen S G M , de Brauw L M , Wildenborg N P , Cuesta M A 
Published: March 2007

Abstract
The management of common bile duct (CBD) stones in patients subjected to laparoscopic cholecystectomy is still a subject of debate. A prospective study was performed of all 699 patients with symptomatic gallstones at risk of CBD stones between mid-1987 and 1994. Based on clinical, biochemical and ultrasonographic criteria, 119 patients underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) with or without endoscopic sphincterotomy. Results showed a high positive predictive value (over 85 per cent) for the presence of CBD stones in patients with acute cholangitis, persistent obstructive jaundice or in the acute phase of gallstone pancreatitis. In the other groups (increased liver enzyme levels, a wide CBD and after resolution of jaundice or pancreatitis) the positive predictive value was less than 25 per cent. The complication rate of ERCP with sphincterotomy was 14 per cent with a mortality rate of 2 per cent. These results argue for more selective use of preoperative ERCP only for patients with acute cholangitis, persistent jaundice or acute gallstone pancreatitis. Other patients at risk of harbouring CBD stones should undergo intraoperative laparoscopic cholangiography and, if stones are found, laparoscopic exploration of the bile duct or postoperative ERCP.
Manipulation of the l-arginine-nitric oxide pathway in experimental colitis
Authors: Neilly P J D , Kirk S J , Gardiner K R , Anderson N H , Rowlands B J 
Published: March 2007

Abstract
The role of the l-arginine-nitric oxide pathway in the pathogenesis of colonic inflammation was assessed using l-arginine and its competitive analogue Nω-nitro-l-arginine methyl ester (l-NAME) in a rat model of colitis. In the first study oral l-arginine 2 per cent (control: 3.4 per cent l-glycine) was administered with and without l-NAME 100 mg/l. Orally administered l-arginine increased colonic inflammation (P = 0.004) and decreased thymic weight (P = 0.0007). Addition of l-NAME reduced the colonic inflammation and prevented loss of body-weight (P &lt; 0.04). In the second study l-NAME was administered orally in concentrations of 100, 200 and 500 mg/l (control: no l-NAME). l-NAME 500 mg/l reduced colonic inflammation and increased thymic weight and body-weight (P &lt; 0.01). Thymic weight and body-weight correlated positively with the concentration of l-NAME administered orally (rs≥0.3, P = 0.04). l-NAME l g/l was administered topically as an enema (control: suspension agent). Topical l-NAME reduced colonic inflammation and increased thymic weight (P &lt; 0.05). These results suggest that the l-arginine-nitric oxide pathway mediates colonic inflammation in this model.
In vitro regulation of human breast cancer cell adhesion and invasion via integrin receptors to the extracellular matrix
Authors: Gui G P H , Puddefoot J R , Vinson G P , Wells C A , Carpenter R 
Published: March 2007

Abstract
The extracellular matrix consists of the interstitium and the basement membrane. Cellular interaction with fibronectin, laminin and collagen provides a possible mechanism by which cancer cells adhere, invade and metastasize. The integrins are a major family of adhesion molecules that recognize epitopes on the extracellular matrix as ligands. These include the α2β1, α3β1, αvβ1 and αvβ5 integrins, most of which were found to be expressed on MCF-7, T47D, MDA-MB-231, ZR75-1 and Hs578T breast cancer cell lines. Each cell line adhered to the matrix proteins in a dose-dependent manner and was inhibited by monoclonal antibodies against relevant integrins. Only Hs578T was significantly invasive through fibronectin but both Hs578T and MDA-MB-231 invaded through laminin and type IV collagen in an in vitro assay. The invasive potential of these cell lines could be inhibited by integrin antibodies added to cells before incubation, but the addition of antibodies after cells were allowed to adhere to the matrix failed to inhibit invasion. Inhibition of cellular adhesion to the matrix reduced the invasive potential of breast cancer cell lines. As integrin antibodies inhibit cell invasion in vitro, the integrins may be of potential value as antitumour therapeutic agents.
Gastric juice epidermal growth factor concentration and Helicobacter pylori in patients with duodenal ulcer
Authors: Tunio A M , Holton J , Hobsley M 
Published: March 2007

Abstract
The level of epidermal growth factor (EGF) was measured in the basal and maximally stimulated gastric juice of 20 control subjects and 20 patients each with duodenal ulcer and non-ulcer dyspepsia. Basal gastric juice was analysed for ammonia and urea concentrations, and the [ammonia]3/[urea] ratio was used to show Helicobacter pylori status, as was the [13C]urea breath test in nine controls. There was complete concordance in the nine controls between the two methods for determining H. pylori status. Twenty-five subjects were H. pylori positive (seven with duodenal ulcer, nine with non-ulcer dyspepsia, nine controls) and 35 H. pylori negative (13, 11 and 11 respectively). In H. pylori-positive subjects, the median EGF concentrations in the stimulated secretion of patients with duodenal ulcer and without (non-ulcer dyspepsia and controls combined) were 46.7 and 18.0 ng/ml (P &lt; 0.001), and in H. pylori-negative subjects were 40.0 and 26.5 ng/ml respectively (P &lt; 0.01). There was no difference in EGF concentration between controls and subjects with non-ulcer dyspepsia irrespective of H. pylori status. Lack of EGF is unlikely to be a cause of duodenal ulcer. The increased EGF concentration in patients with ulcer bore no relationship to the H. pylori status of the individual. If this bacterium causes duodenal ulcer, it is not via a reduction in EGF concentration.
Percutaneous transluminal angioplasty for lower-limb critical ischaemia
Authors: London N J M , Varty K , Sayers R D , Thompson M M , Bell P R F , Bolia A 
Published: March 2007

Abstract
Percutaneous transluminal angioplasty (PTA) alone was used to treat 54 (23 per cent) of 232 lower limbs with critical ischaemia. Technical success was achieved in 49 cases (91 per cent) with an immediate symptomatic improvement in 47 (87 per cent). There was no death or limb loss attributable to PTA and three embolic complications were successfully treated by percutaneous aspiration. Symptomatic improvement and haemodynamic patency rates at 24 months were 77 and 78 per cent respectively; 27 of 34 limbs with ulceration or gangrene had healed with minor surgery by a median of 7.5 (range 3.0–18.0) months. Patient survival and limb salvage rates at the same time interval were 76 and 89 per cent respectively. These results demonstrate that, for a selected group of patients with lower-limb-critical ischaemia, PTA can be a highly successful therapeutic option with a low associated morbidity.
Preoperative chemotherapy for stage III–IV gastric carcinoma: Feasibility, response and outcome after complete resection
Authors: Fink U , Schuhmacher C , Stein H J , Busch R , Feussner H , Dittler H J , Helmberger A , Böttcher K , Siewert J R 
Published: March 2007

Abstract
Despite extensive resection and systematic lymphadenectomy the prognosis of patients with locally advanced gastric carcinoma remains poor. The effect of preoperative outpatient chemotherapy with etoposide, doxorubicin and cisplatin was evaluated prospectively in 30 patients who had been shown by preoperative staging (including endosonography and surgical laparoscopy) to have gastric carcinoma stages IIIA, IIIB or IV. Haematological side-effects were common and necessitated hospitalization in 13 of 30 patients. Complete clinical response to neoadjuvant therapy was observed in eight of 27 evaluable patients. Resection was performed in 27 of 30 patients, with complete macroscopic and microscopic tumour removal in 24. There were no deaths and no major morbidity following operation. On multivariate analysis complete clinical response (P&lt;0.01) and complete tumour resection (P&lt;0.01) were the major independent predictors of long-term survival after neoadjuvant chemotherapy. Actuarial survival after complete tumour removal was superior with neoadjuvant therapy compared with results in an age-, sex- and tumour stage-matched control population who had primary resection (P=0.07). Recurrence occurred in 17 of 23 evaluable patients who had complete tumour removal, with relapse in the tumour bed or area of lymphatic drainage in 11. These data show that neoadjuvant therapy in patients with locally advanced gastric carcinoma is feasible and appears to increase the rate of complete tumour removal. More powerful and less toxic regimens are, however, required to improve the response rate and to delay or avoid recurrence after neoadjuvant chemotherapy.
Macroscopically node-negative but histologically node-positive gastric carcinoma
Authors: Adachi Y , Mori M , Maehara Y , Sugimachi K 
Published: March 2007

Abstract
The features of macroscopically node-negative but histologically node-positive (N(−) n(+)) tumours were examined in 521 patients undergoing curative surgery for gastric carcinoma. Of 240 histologically node-positive tumours, 62 (26 per cent) were N(−) n(+). The 10-year survival rate of patients with N(−) n(+) tumour at 66 per cent was worse than that of those with histologically node-negative tumour (91 per cent) (P&lt;0.01) but better than that of patients with macroscopically and histologically node-positive tumour (40 per cent) (P&lt;0.01). N(−) n(+) tumour was characterized by size less than 5 cm (47 per cent), invasion not beyond the muscularis propria (53 per cent), lymph node metastasis limited to group 1 nodes (76 per cent), number of positive nodes fewer than seven (90 per cent) and disease of stage II (52 per cent). The survival of patients with N(−) n(+) tumour was determined by the number of positive nodes and stage of disease. N(−) n(+) tumours are associated with a better outcome, owing to less progressive disease, and the number of positive nodes is a prognostic indicator.
Intraoperative radiotherapy for pancreatic carcinoma
Authors: Kasperk R , Klever P , Andreopoulos D , Schumpelick V 
Published: March 2007

Abstract
Intraoperative radiotherapy (IORT) with an electron beam is a therapeutic modality employed predominantly in tumours with a high risk of local recurrence. In this department 35 patients with proven adenocarcinoma of the pancreas underwent surgery and IORT, while 41 patients underwent surgery only. Irradiated patients suffered more serious postoperative complications (21 per cent versus 7 per cent), spent more time in hospital (32 days versus 26 days) and did not show a survival advantage (median of 326 days versus 366 days for two patients with curative resection). Anastomotic breakdown (twp patients), abscess formation (two patients) and pancreatitis in the pancreatic remnant (one patient) occurred only in this group. It is concluded that IORT may increase the risk of postoperative complications. As, on the basis of experimental data, an additional serious long-term risk is to be expected, application of IORT should be limited to well controlled study conditions.
Intraoperative risk factors associated with hepatic resection
Authors: Tanabe G , Sakamoto M , Akazawa K , Kurita K , Hamanoue M , Ueno S , Kobayashi Y , Mitue S , Ogura Y , Yoshidome N , Baba M , Aikou T 
Published: March 2007

Abstract
Risk factors associated with complications following hepatic resection were investigated retrospectively in 121 patients between January 1987 and April 1992. Fifty-seven patients recovered uneventfully, but 64 suffered postoperative complications and 15 died within 3 months. All those who died had suffered from hyperbilirubinaemia or bleeding and/or coagulopathy, which were considered critical complications after hepatic resection. Risk factors following hepatic resection were investigated statistically. Stepwise logistic regression analysis showed that serum levels of cholinesterase, the histology of the remaining liver and the volume of intraoperative blood loss were significantly associated with major complications (odds ratio 0.02, 5.14 and 4.97 respectively). Coexisting liver cirrhosis, deterioration of liver protein synthesis and massive intraoperative blood loss are important risk factors following hepatic resection.
Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic treatment of choledocholithiasis
Authors: Millat B , Fingerhut A , Deleuze A , Briandet H , Marrel E , De Seguin C , Soulier P 
Published: March 2007

Abstract
Laparoscopic common bile duct (CBD) exploration was attempted in 115 of 121 consecutive unselected patients with choledocholithiasis (mean age 69 (range 21–92) years) found during routine intraoperative cholangiography. The CBD was successfully cleared of all stones in 100 patients (87 per cent). Ten of 11 patients referred for surgery after failure of endoscopic sphincterotomy had complete laparoscopic choledocholithiasis. Eleven patients (10 per cent) required conversion to open CBD exploration, and laparoscopic exploration was not attempted in six (5 per cent) because of inflammation or fibrosis. Postoperative endoscopic sphincterotomy was required in four patients (4 per cent) for retained stones after laparoscopic exploration. There were no postoperative deaths (39 per cent of patients were aged 75 years or more). Routine intraoperative cholangiography, and when required laparoscopic CBD exploration, should be compared in randomized trials with preoperative endoscopic retrograde cholangiography in patients with suspected choledocholithiasis.
Non-surgical trauma to the extrahepatic biliary tract
Authors: Parks R W , Diamond T 
Published: March 2007

Abstract
Non-surgical trauma to the extrahepatic biliary tract is uncommon and encountered only rarely by surgeons outside specialist hepatobiliary centres. Such injury often results in significant morbidity and mortality. This review outlines the incidence, classification, mechanisms of injury, presentation, diagnostic techniques and management options. Depending on the type of biliary injury identified, an optimal method of repair is suggested. Recommendations are made for surgeons who encounter this type of injury and do not have the appropriate expertise for definitive management.
Use of lightguide spectrophotometry to quantify skin oxygenation in a variable model of venous hypertension
Authors: Hanna G B , Newton D J , Harrison D K , Belch J J F , McCollum P T 
Published: March 2007

Abstract
A variable model of venous hypertension was used to examine the immediate effect on skin oxygenation and blood flow. Measurements were carried out using laser Doppler flowmetry, transcutaneous oximetry and both macro- and micro-lightguide spectrophotometry to measure haemoglobin saturation (So2). Assessments were performed on 20 normal subjects and in ten patients with deep venous insufficiency lying supine with a pressure cuff left uninflated (P0), then inflated to 40 mmHg (P40), 60 mmHg (P60) and 80 mmHg (P80). All measurements were performed at the gaiter area of the leg. In normal subjects median Doppler values fell significantly at P40 (P&lt;0±001) but further pressure increases had no more effect. Mean values of transcutaneous partial pressure of oxygen (Pteo2) fell steadily (P&lt;0±001), although the initial fall at P40 was small. Median So2 fell with increasing occlusion pressure with both macro- and micro-lightguide spectrophotometry (P&lt;0±001), although the main reduction occurred predominantly at lower occlusion pressures. Higher levels of So2 were obtained with local heating up to 44°C, with a pattern similar to that of Ptco2. In patients, the same pattern of response to increased venous pressure occurred in areas of clinically normal skin. These data suggest that small increases in venous hypertension have an immediate and profound influence on skin blood flow and oxygen availability in normal skin.
Critical limb ischaemia in patients over 80 years of age: Options in a district general hospital
Authors: Humphreys W V , Evans F , Watkin G , Williams T 
Published: March 2007

Abstract
A total of 114 reconstructions were performed in 82 octogenarian patients and the results compared with those of 33 patients who had primary amputation. The operative mortality rate was higher after amputation (45 versus 11 per cent) and the mean survival less (25 versus 34 months). Quality of life assessment using a Rosser scale suggested that, although there was no improvement in the 38 per cent with a failed reconstruction, there was a significant improvement in the 62 per cent whose reconstruction remained patent. There was minimal improvement in quality of life after primary amputation and this was due to relief of pain. Costs (including the costs of revisions and community costs) were assessed in detail. Although the mean total operative costs of reconstruction were higher than those of amputation (£10222 versus £6475) this was more than offset by teh high community costs of amputation. The total cost of reconstruction was £13546, compared with £33095 for amputation. Following reconstruction 66 per cent of those patients independent before critical limb ischaemia occurred were able to return to their own home; only 33 per cent of amputees were able to do so.
Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: A randomized trial
Authors: McMahon A J , Ross S , Baxter J N , Russell I T , Anderson J R , Morran C G , Sunderland G T , Galloway D J , O'Dwyer P J 
Published: March 2007

Abstract
In a randomized controlled trial, 299 patients were sent a symptoms questionnaire 1 year after laparoscopic (n = 151) or minilaparotomy (n = 148) cholecystectomy for symptomatic cholelithiasis. The response rate to the questionnaire from contactable patients was 86 per cent. In both groups, at least 90 per cent of patients reported that their symptoms were improved, and at least 93 per cent rated the success of their operation as ‘excellent’, ‘good’, or ‘fair’. However, over half the patients reported abdominal pain, a quarter reported flatulence, and a quarter dyspepsia. The only difference between treatment groups was that a higher proportion of patients who underwent minilaparotomy reported heartburn (35 per cent versus 19 per cent, P = 0±005). Patients who reported a ‘poor’ outcome were more likely to have suffered a postoperative complication, had lower quality of life scores, and higher anxiety and depression scores. Both laparoscopic and minilaparotomy cholecystectomy result in symptomatic benefit in at least 90 per cent of patients with symptomatic cholelithiasis.
Clinical and physiological evaluation of anorectal eversion during restorative proctocolectomy
Authors: Williamson M E R , Lewis W G , Miller A S , Sagar P M , Holdsworth P J , Johnston D 
Published: March 2007

Abstract
Fifty patients had a restorative proctocolectomy with stapled end-to-end ileoanal anastomosis by the eversion technique. Median (interquartile range) maximum resting anal pressure was 90 (73–116) cmH2O before restorative proctocolectomy and 71 (51–88) cmH2O 1 year after surgery (P&lt;0±001). Median maximum squeeze pressure was 141 (110–185) cmH2O before surgery and 146 (118–186) cmH2O 1 year after surgery (P not significant). Median thresholds for sensation in the lower third of the anal canal before and 1 year after surgery were 5±3 and 7±1 mA, respectively (P=0±006). One year after restorative proctocolectomy, all patients were continent, although two experienced leakage of mucus requiring a pad. Forty-two patients (84 per cent) could discriminate between faeces and flatus. Eversion of the anorectum during restorative proctocolectomy impairs the motor and sensory functions of the anal sphincter. Most patients achieved satisfactory anal continence, however, despite these physiological changes.
Role of total pancreatectomy in the treatment of patients with end-stage chronic pancreatitis
Authors: Fleming W R , Williamson R C N 
Published: March 2007

Abstract
Forty patients underwent total pancreatoduodenectomy for end-stage chronic pancreatitis. There were 34 men and six women of median age 39 (range 21–66) years. Alcoholism was the major aetiological agent (30 patients), and five patients had had previous acute idiopathic pancreatitis. The overwhelming indication for operation was severe abdominal pain, complicated by failing exocrine and endocrine function. Resection was performed in one (17 patients) or two (23) stages, following previous proximal (seven) or distal (16) pancreatectomy; progression from partial to total pancreatectomy occurred over an interval of 8–96 (median 15) months. A further six patients had undergone previous pseudocyst or duct drainage procedures. The pylorus was preserved in 28 patients and the spleen in ten. Median operating time was 6 (range 2±5–8±5) h and median blood loss 2000 (range 500–16000) ml. There were two hospital deaths and three patients required reoperation. Of 38 survivors, 30 obtained complete or substantial relief of pain. There were 15 late deaths at 2±5–120±0 months after operation, 13 in the alcohol group and 11 disease-related. Total pancreatectomy can relieve the intractable pain of chronic pancreatitis at the cost of possible premature death from continuing alcohol abuse.