bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term follow-up after open cholecystectomy
Authors: Konsten J , Gouma D J , von Meyenfeldt M F , Menheere P 
Published: March 2007

Abstract
The long-term outcome of open cholecystectomy was investigated. Follow-up data at a median of 10 years were obtained from physicians' records on 325 (92·6 per cent) of 351 patients treated for symptomatic gallbladder stones by open cholecystectomy between 1978 and 1980. One 79-year-old patient died after operation, from a pulmonary complication. Of the 325 patients, 81·5 per cent were currently asymptomatic or had not had symptoms during follow-up until death. Sixty patients (18·5 per cent) had complaints after 10 years. Stone recurrence was found in five patients (1·5 per cent); ten others (3·1 per cent) had biliary tract-related complaints during follow-up. Blood samples were obtained in 67·3 per cent of surviving patients with biliary complaints. There were no laboratory findings associated with biliary obstruction. Patients with typical symptoms of gallstone disease before surgery had significantly fewer complaints during follow-up than those with typical as well as atypical symptoms (14·8 versus 26·5 per cent, P &lt; 0·02). However, most of these complaints were not related to the procedure. It is concluded that the majority of patients reported no complaints or postcholecystectomy symptoms 10 years after surgery.
Plasminogen activator inhibitor 2 reduces peritoneal fibrinolytic activity in inflammation
Authors: Whawell S A , Vipond M N , Scott-Coombes D M , Thompson J N 
Published: March 2007

Abstract
Fibrinolysis in peritoneal tissue may play a role in the development of intra-abdominal adhesions. The plasminogen-activating capacity of human peritoneum results largely from the presence of tissue plasminogen activator (tPA). Inflammation reduces peritoneal plasminogenactivating activity and leads to the appearance of plasminogen activator inhibitor (PAI) type 1. The role of PAI-2 in the inhibition of peritoneal fibrinolysis during inflammation was investigated in this study. The plasminogen-activating activity of peritoneal biopsy homogenates (seven inflamed, seven normal), measured using a fibrin plate technique, was reduced in inflamed compared with normal tissue (median &lt;0·07 versus 13·9 units/cm2, P &lt; 0·01); tPA antigen levels were not significantly different (median 1·02 versus 1·34 ng/ml). PAI-1 and PAI-2 antigens were not detected in normal human peritoneum but were present in inflamed peritoneum (median concentration 8·8 ng/ml for PAI-1, 26·7 ng/ml for PAI-2). These inhibitors may be important factors in adhesion formation by contributing to the abolition of peritoneal plasminogen-activating activity.
Controlled trial of wound infiltration with bupivacaine for postoperative pain relief after appendicectomy in children
Authors: Wright J E 
Published: March 2007

Abstract
A double-blind controlled trial was performed to assess the effectivene, of wound infiltration with bupivacaine for postoperative pain relief after appendicectomy in children. Sixty children entered the trial and 52 completed it; they were randomized to receive bupivacaine or placeb Assessment of postoperative pain using a numerical scoring system was made by the child, the recovery sister and the ward sister, and 52 measurement of the time between the end of the operation and the need for narcotic injection. Analysis revealed significantly less pain (P &lt; 0·03) in the immediate postoperative period in the treated ground The use of bupivacaine wound infiltration as a supplement to other current methods of pain control is recommended.
Ischaemia—reperfusion injury in the rat kidney: Effect of a single dose of sodium bicarbonate
Authors: Lennon G M , Ryan P C , Fitzpatrick J M 
Published: March 2007

Abstract
The protective effect of intravenous 8·4 per cent sodium bicarbonate on renal function after ischaemia was evaluated in rats subjected to 45 or 90 min warm unilateral renal ischaemia. Two groups of control animals received normal or 3 per cent saline. All solutions were given by bolus injection 3 h before ischaemia. Renal function was significantly protected in animals receiving bicarbonate. Vascular congestion of the inner stripe of the renal medulla was prevented. The survival rate in the group undergoing 90-min ischaemia was 70 per cent for animals receiving bicarbonate and nil in those given saline. Preoperative alkalinization confers significant functional and morphological protection in the ischaemic kidney.
Simultaneous dynamic electromyographic proctography and cystometrography
Authors: Thorpe A C , Williams N S , Badenoch D F , Blandy J P , Grahn M F 
Published: March 2007

Abstract
The rectum and bladder share a common origin and work in harmony; disturbance in one may lead to a similar problem in the other. The two have, however, not previously been investigated dynamically and simultaneously. A new system has been devised allowing dynamic integrated electromyographic proctography to be performed simultaneously with cystometrography in 41 patients (28 women and 13 men). Of 16 women with chronic constipation who underwent the combined study, ten were shown to have obstructed micturition. Eight of these ten women exhibited an inappropriate contraction of the puborectalis muscle during micturition, compared with one of the six with normal micturition (P = 0·02). Of the patients with obstructed micturition, seven of eight women with a rectocele also had anismus, compared with none of four women with a rectocele among those who were able to micturate normally (P = 0·02). Eight of the ten women with obstructed micturition thus had a proctological abnormality that explained the urological symptoms. Of 12 women with idiopathic faecal incontinence who underwent the combined study, eight were shown to have genuine stress incontinence of urine. In seven of these the severity was shown to be of type 2a or greater, indicating that pelvic floor dysfunction may be the causal factor of both rectal and urinary symptoms. The combined study shows abnormalities in one system that could explain similar symptoms in the other.
Carotid endarterectomy improves haemodynamics on the contralateral side: implications for operating contralateral to an occluded carotid artery
Authors: Markus H S , Harrison M J , Adiseshiah M 
Published: March 2007

Abstract
The importance of the patency of the contralateral carotid artery on the haemodynamic effect of a carotid stenosis was investigated. The breath-holding index was used to estimate cerebral perfusion reserve. The percentage rise in middle cerebral blood flow velocity, measured by transcranial Doppler ultrasonography, occurring during breath-holding was divided by the time of breath-holding. In study 1, ten subjects with no carotid stenosis, 13 with unilateral and eight with bilateral stenosis were studied. For unilateral stenosis the breath-holding index was reduced on the stenosed side compared with normal (0·85 versus 1·34 per cent per s, P &lt;0·05). For bilateral disease, in the presence of severe stenosis on the side contralateral to that being examined, even a moderate stenosis (30–50 per cent) resulted in a much greater reduction in the breath-holding index. In study 2, the breath-holding index was measured before and after carotid endarterectomy in ten patients. The index increased significantly following operation, not only on the operated side (1·31 versus 0·79 per cent per s, P &lt;0·01), but also on the contralateral side (1·23 versus 0·87 per cent per s, P &lt;0·05). In three of four patients with contralateral stenosis &gt;90 per cent or occlusion, operation improved the breath-holding index markedly (&gt;90 per cent) on the non-operated side above the stenosis or occlusion. These results demonstrate the importance of patency of the contralateral carotid artery in determining the haemodynamic effect of a carotid stenosis. In addition, operating contralateral to an occlusion may improve haemodynamic status above the occlusion. Implications in selecting patients for carotid endarterectomy are discussed.
Critical leg ischaemia: an appraisal of clinical definitions
Authors:   Joint Vascular Research Group, Tyrrell M R , Wolfe J H N 
Published: March 2007

AbstractThe reliable prediction of imminent limb death remains a clinical problem. The International Vascular Symposium and European working parties each produced similar definitions of “critical ischaemia”, but this is the first attempt to address the issue with prospectively collected data. Complete 3-year follow-up data were available for 213 patients. In addition to the above two definitions, a simplified modification has been evaluated, after review of the data 1 year into this study. All three definitions were able to identify patients likely to require amputation in the absence of successful reconstruction. The sensitivity, specificity and positive predictive values with which they were able to do so was, however, poor. None of the definitions was able to predict which diabetic patients would require amputation. Diabetics were more likely to undergo amputation than non-diabetics. There was, however, no significant difference in the initial ankle artery pressures between the diabetic and non-diabetic patient subgroups. None of the definitions reliably predicted which grafts would occlude, in which event the 3-year mortality rate was approximately 35 per cent. Critical ischaemia by any of these definitions is associated with a high mortality rate. Arterial reconstruction is associated with a reduction in both mortality and amputation rates These data do not support the hypothesis that critical ischaemia is associated with a greater graft occlusion rate than lesser degrees of severe ischaemia.
Femoral hernia: intestinal obstruction is an unrecognized source of morbidity and mortality
Authors: Chamary V L 
Published: March 2007

Abstract
A total of 180 consecutive femoral hernia repairs, consisting of 100 emergency and 80 elective admissions between January 1979 and December 1986, were reviewed. Morbidity was greater in the emergency than in the elective group (P &lt;0·01) and was significantly related to intestinal obstruction (P &lt;0·001), a feature not previously highlighted. Intestinal obstruction also had an important association with mortality, which was confined to patients undergoing emergency surgery. Patients with intestinal obstruction are a high-risk group and require careful perioperative management. Wound infection predisposed to recurrence of femoral hernia (P &lt;0·01). Repair of recurrent hernia in patients treated electively was associated with an increased incidence of chest infection (P &lt;0·001). Prophylactic measures, including antibiotics, may help to reduce recurrence and its associated morbidity. Patients referred with an inguinal lump or hernia, as opposed to a femoral hernia, had a later outpatient appointment and consequently a later operation date (P &lt;0·02). All elderly patients referred with any groin lump should receive an early outpatient appointment.
Life quality and psychological morbidity with an ileostomy
Authors: Awad R W , El-Gohary T M , Skilton J S , Elder J B 
Published: March 2007

Abstract
The recent introduction of restorative proctocolectomy for the treatment of ulcerative colitis has reopened the debate about the effects of ileostomy on quality of life. This study analysed life quality and psychological morbidity in 113 patients with an ileostomy using a postal questionnaire which included questions about their opinion of the pouch operation. Of the questionnaires, 73 per cent were suitable for analysis. A total of 93 per cent of those responding were happy with the ileostomy and appeared to have adapted to a normal life with it. Some 87 per cent stated that they would keep the ileostomy in preference to an ileoanal pouch. In addition, psychological morbidity as assessed by the General Health Questionnaire occurred in only 5 per cent of patients.
Emergency laparoscopic surgery
Authors: Paterson-Brown S 
Published: March 2007

Abstract
The acute abdomen continues to demand a large proportion of the general surgeon's workload. Recent studies have demonstrated that management errors can be significantly reduced using selective laparoscopy and this should now become routine practice. The continuing advances in laparoscopic surgery that permit many emergency procedures to be performed by this route provide increased impetus for a combined approach using diagnostic and therapeutic laparoscopy for the management of the acute abdomen. Results of current studies must be awaited before the exact role of emergency laparoscopic surgery can be defined, but early reports suggest several advantages in using laparoscopy to manage conditions such as acute appendicitis, perforated peptic ulcer and gynaecological emergencies.
Elective lymph node dissection in the management of malignant melanoma
Authors: Scott R N , McKay A J 
Published: March 2007

Abstract
The surgical management of regional nodes in patients with cancer has been controversial for many years. This paper reviews the role of elective lymph node dissection in the management of malignant melanoma. The evidence for and against elective lymphadenectomy is discussed and a policy of therapeutic, rather than elective, lymph node excision recommended.
Splenectomy for splenomegaly exceeding 1000 grams: Analysis of 47 patients
Authors: Letoquart J-P , La Gamma A , Kunin N , Grosbois B , Mambrini A , Leblay R 
Published: March 2007

Abstract
Forty-seven patients who underwent splenectomy for splenomegaly ⩾1000 g were studied retrospectively. There were 29 men and 18 women of mean age 56 (range 19–87) years. Haematological malignancy was the most common disorder (42 patients). The main indications for splenectomy were cytopenia (20 patients), diagnosis (14), initial treatment of leukaemia (eight), pain (four) and spontaneous rupture (one). Thirteen patients underwent an associated surgical procedure. One patient died (mortality rate 2 per cent) and 12 (26 per cent) had postoperative complications. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, effective initial treatment in prolymphocytic and hairy cell leukaemia, definitive relief of pain in all affected patients, and long-term improvement of cytopenia in most.
Repeat liver resection for recurrent colorectal metastases
Authors: Vaillant J-C , Balladur P , Nordlinger B , Karaitianos I , Hannoun L , Huguet C , Parc R 
Published: March 2007

Abstract
Sixteen patients underwent 18 repeat liver resections for recurrence of colorectal hepatic metastases that had been previously resected. Only minor liver resection had been undertaken at the first operation; three were palliative. The second operation was major hepatectomy in ten patients, minor resection in five and orthotopic liver transplantation in one. In one patient, lung metastases were resected before the second operation. One repeat hepatectomy was palliative. After partial liver resection, there were no deaths and complications were observed in six of 15 patients. One patient died 2 weeks after liver transplantation. After the second resection, 2-, 3- and 5-year survival rates were 67, 57 and 30 per cent; the mean survival time was 33 (range 8–93) months. Tumour recurrence was observed in 11 of 14 patients 4–32 (mean 13) months after a second curative liver resection; two patients received a third curative operation for recurrent liver metastases. After the second curative hepatectomy, seven patients died from disease after a mean of 36 (range 14–61) months and seven are currently alive at a mean of 33 (range 8–93) months. Four of these patients are free from disease 26–93 months after resection and three are alive with recurrence. Repeat hepatectomy for recurrent colorectal metastases can prolong survival in selected patients and has low operative risk.
Intragastric bile acid and symptoms in patients with an intrathoracic stomach after oesophagectomy
Authors: Chattopadhyay T K , Shad S K , Kumar A 
Published: March 2007

Abstract
Bile acid concentration and symptoms were evaluated in 24 patients after total oesophagectomy and gastric pull-up. Patients were randomly allocated to receive pyloroplasty or not. After operation all were followed for a minimum of 6 months. Bile acid concentration in the gastric juice was estimated. The mean(s.d.) bile acid concentration 6 months after surgery was similar in patients with and without pyloroplasty (34.9(30.1) and 25.0(24.2) mg/dl respectively). Postprandial discomfort and bilious eructations were the two most commonly observed symptoms in both groups. Other features noted were vomiting, anaemia and anorexia. These did not however seem to be related to intragastric bile acid concentration of individual patients in either group and occurred irrespective of whether pyloroplasty was performed or not.
Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985
Authors: Hansson L-E , Sparén P , Nyrén O 
Published: March 2007

Abstract
Several American, Japanese and European centres have reported an increase in carcinoma of the gastric cardia, contrary to the general trend in the incidence of gastric cancer. The aim of this nationwide population-based study was to describe trends in the incidence of tumours of the gastric cardia in Sweden over the 16-year period from 1970 to 1985. The Swedish cancer register, which is more than 95 per cent complete, was used to identify cases. There were 1514 men and 481 women with cancer of the gastric cardia. The age-standardized rates increased in men from 1.9 per 105 population in 1970–1973 to 3.0 per 105 in 1982–1985, corresponding to a mean annual increase of 2.5 per cent (95 per cent confidence interval (c.i.) 1.6–3.4 per cent). In women, the age-standardized rates increased from 0.5 per 105 in 1970–1973 to 0.8 per 105 in 1982–1985, the mean annual increase being 0.9 per cent (95 per cent c.i. 0.0–1.8 per cent). The highest incidences were found in southern Sweden, contrary to the geographical distribution of gastric cancer in general, which shows a south-to-north gradient. The disparate epidemiological features of cancer of the cardia and gastric cancer at other sites suggest that the aetiologies may also be different. Since little is known about the aetiology of cancer of the cardia, and the incidence seems to be rising rapidly, analytical studies are urgently needed.
Gastric cancer and Helicobacter pylori infection
Authors: Buruk F , Berberoglu U , Pak I , Aksaz E , Celen O 
Published: March 2007

Abstract
Gastric adenocarcinoma can be divided into two histopathological types: intestinal and diffuse. In addition to the role of environmental factors, an association between gastric cancer and Helicobacter pylori has been suggested. A retrospective study was therefore carried out among 46 patients who had gastric cancer. As a control group, 40 patients with non-malignant disorders were selected (11 patients with peptic ulcer, 12 with chronic superficial gastritis, 17 with chronic atrophic gastritis). Twenty-six cancers were classified as intestinal type and 20 as diffuse type. H. pylori was found in 23 (88 per cent) of the intestinal type and 11 (55 per cent) of the diffuse type (P &lt; 0.05). Patients with the intestinal-type gastric cancer had a higher prevalence of H. pylori infection than those with gastric ulcer (55 per cent) and chronic superficial gastritis (50 per cent) (P &lt; 0.05). These findings suggest that there is a possible association between the intestinal type of gastric cancer and H. pylori infection.
Intraoperative assessment of nodal status in the selection of patients with breast cancer for axillary clearance
Authors: Fisher C J , Boyle S , Burke M , Price A B 
Published: March 2007

Abstract
Preliminary axillary node sampling with intraoperative reporting of imprint cytology to detect positive nodes was assessed in 50 consecutive patients with T1 or T2 breast cancer undergoing axillary clearance, 21 of whom were histologically node positive. A mean of 3.5 (range 1–4) nodes were sampled. Axillary clearance yielded a mean of 11.7 (range 4–32) nodes. Of node-positive patients, sampled nodes detected 18 of 21 on immediate processing, one on subsequent paraffin sections, and failed to detect two (one of ten and one of 17 positive nodes). If the technique had been used during operation to select patients for axillary clearance, 29 of 50 would have avoided the operation, one of two node-positive patients would have required delayed axillary treatment and two of 21 with minimal axillary disease would not have received further axillary treatment or adjuvant therapy. The technique may be useful in reducing the morbidity of breast cancer surgery without increasing the risk of locoregional or distant recurrence.
Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy
Authors: Pierie J P E N , de Graaf P W , Poen H , van der Tweel I , Obertop H 
Published: March 2007

Abstract
Benign anastomotic stricture after transhiatal oesophagectomy and gastric tube reconstruction constitutes a major problem. From August 1988 to April 1991, 81 patients were followed after cervical oesophagogastrostomy. Twenty-four patients (30 per cent) developed a benign anastomotic stricture 3–23 (median 8) weeks after operation. Poor vascularization of the gastric tube, determined during operation, and postoperative anastomotic leakage were statistically significant risk factors for stricture formation. Symptoms related to stricture were often typical and were confirmed by endoscopy and/or radiography. Radiography did not yield information additional to that obtained from endoscopy. Strictures were treated in the outpatient clinic by dilatation with Savary dilators. Repeated dilatation completely alleviated dysphagia in 20 of the 24 patients (83 per cent). In ten patients dilatations could be discontinued after a median of 8 (range 1–17) sessions. Dilatation was continued until the end of follow-up in nine patients or until death from recurrent disease in five. No complications of dilatation were seen.
Ultrasonography during liver resection for hepatocellular carcinoma
Authors: Lau W Y , Leung K L , Lee T W , Li A K C 
Published: March 2007

Abstract
Seventy-nine consecutive patients underwent elective laparotomy for symptomatic hepatocellular carcinoma between 1986 and 1992. In the first 4 years, 51 patients received liver resection without intraoperative ultrasonography. In the subsequent 2 years, ultrasonography was performed during operation on 28 patients; three were found to have inoperable tumours. The technique located tumours in two patients and changed the extent of liver resection in another two. Eight of 51 patients (16 per cent) who had the parenchymal transection plane determined clinically had histological evidence of tumour infiltration of the resection margins, compared with none of 25 in whom the plane was determined by ultrasonography. This difference was significant (P = 0.034). The use of intraoperative ultrasonography improved patient survival, although this was not statistically significant. The median survival of patients with adequate resection margins was 9.2 months, compared with 3.9 months in those with inadequate margins. Intraoperative ultrasonography is useful in surgery for hepatocellular carcinoma.