bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immediate and early follow-up results of pulse spray thrombolysis in patients with peripheral ischaemia
Authors: Yusuf S W , Whitaker S C , Gregson R H S , Wenham P W , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Pulse spray thrombolysis is a technique of accelerated peripheral thrombolysis which has been evaluated in 38 patients, 29 with threatened limb viability and nine with a viable but critically ischaemic limb. The median length of occlusion was 26·5 (range 3–65) cm. The lytic agent used was recombinant tissue plasminogen activator (rtPA), injected manually via a pulse spray catheter at a concentration of 0·33 mg/ml and a bolus size of 0·2ml. The median total dose of rtPA was 18 (range 5–35) mg. Patency and flow were completely restored in 34 of 38 patients and clinical success at 30 days was maintained in 27 of 38. The median lysis time was 120 (range 35–1125) min, compared with a median duration of 1545 (range 42–5760) min in 120 consecutive patients previously treated with conventional low-dose infusion thrombolysis using rtPA. This represents a 12-fold reduction in lysis time (P &lt; 0·001). The overall estimated cumulative limb salvage rate for the 38 patients who entered the study was 84 per cent and the cumulative patency rate for the 34 patients in whom patency was restored was 74 per cent at 18 months follow-up. Pulse spray thrombolysis rapidly restores patency with good limb salvage at 30 days; the benefit is sustained even in patients with limbs at immediate risk of irreversible ischaemic injury who are not considered suitable for conventional thrombolysis.
Radical orchidectomy and benign testicular conditions
Authors: Robertson G S M 
Published: March 2007

Abstract
The records of 149 patients who underwent testicular exploration for suspected malignancy were reviewed retrospectively. Malignancy was confirmed in 102 patients but benign pathology was noted in 47. Patients with benign disease were older, more likely to be Asian, gave a longer history and on examination were less likely to have a testicular mass. Increased levels of tumour markers, and ultrasonographic and operative appearance of the testis were highly predictive; with ultrasonography having a sensitivity of 100 per cent but a specificity of only 36 per cent for malignancy. Preoperative ultrasonography and an awareness of the potentially benign nature of many lesions with the use of frozen-section biopsy, where appropriate, may allow a decrease in the currently high rate of unnecessary orchidectomy without missing testicular malignancy.
Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus
Authors: Molloy R G , McCourtney J S , Anderson J R 
Published: March 2007

Abstract
The role of laparoscopy in determining suitability for resection was prospectively evaluated in 244 patients with cancer of the gastric cardia and oesophagus. Laparoscopy enabled detection of inoperable disease in 92 patients (38 per cent), several of whom had more than one contraindication to surgery. Hepatic metastases (n = 75, 31 per cent), extensive peritoneal (n = 25, 10 per cent) or lymph node involvement (n =5, 2 per cent) and direct invasion of the liver or colon (n = 5, 2 per cent) were considered contraindications to surgery. Laparoscopy was poorly tolerated in a further 11 (5 per cent) patients, who were not considered suitable for resection. Extra- abdominal metastatic disease was detected in 17 patients who appeared normal at laparoscopy, and a further six patients refused surgery. The remaining 118 patients underwent laparotomy with a view to resection which was successful in 85 (72 per cent). Laparoscopy thus prevented ill-advised laparotomy in 103 patients (42 per cent), either because of extensive intra-abdominal disease or poor tolerance to anaesthesia. Laparoscopy may be a valuable investigation when used to assess the feasibility of resection.
Helicobacter pylori infection in perforated peptic ulcer disease
Authors: Sebastian M , Chandran V P Prem , Elashaal Y I M , Sim A J W 
Published: March 2007

Abstract
This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.
Long-term survival in children with renal carcinoma: Report of two surgically treated cases
Authors: Marcus R , Watt J 
Published: March 2007

Abstract
Renal carcinoma in childhood is rare. Approximately 177 cases have been reported in the English literature and 71 in the Japanese literature1, 2. The Mersey Regional Cancer Registry has recorded only one case of renal carcinoma in a patient below the age of 20 years in the 19-year period since 1975. The annual incidence of this disease in children in the USA is four per 1 million3. Onus rests on authors to report the long-term follow-up of such cases, otherwise it is difficult to assess the results of treatment1.
Laparoscopic cholecystectomy minimally impairs postoperative cardiorespiratory and muscle performance
Authors: Delaunay L , Bonnet F , Cherqui D , Rimaniol J M , Dahan E , Atlan G 
Published: March 2007

Abstract
Surgery elicits a subjective feeling of postoperative fatigue, at least partly related to an impairment in cardiorespiratory function and muscle performance. Laparoscopic surgery is reported to impair the patient's condition minimally. The aim of this study was to assess exercise performance in patients scheduled for elective laparoscopic cholecystectomy. Nine patients assessed as having American Society of Anesthesiologists (ASA) grade I were enrolled in the study. Subjective feelings of fatigue (measured on a visual analogue scale), and heart rate, systemic arterial pressure oxygen consumption and carbon dioxide production responses to graded exercise testing, were assessed before operation and on days 3 and 10 after operation. There were no significant differences in any of these measurements, at rest or during exercise, between the preoperative and postoperative values. Uncomplicated laparoscopic cholecystectomy does not impair postoperative cardiorespiratory and muscle performance or induce significant postoperative fatigue in patients with ASA I, allowing rapid recovery.
Choledochal cysts in adults
Authors: Hewitt P M , Krige J E J , Bornman P C , Terblanche J 
Published: March 2007

Abstract
Fourteen adults who presented with choledochal cysts were studied. Symptoms in most cases were non-specific, which resulted in delayed diagnosis. Associated extracystic hepatobiliary disease occurred in 11 patients, including two with cholangiocarcinoma. Nine patients underwent total cyst excision (eight Todani classification type I and one type II), while four with type IVa cysts had excision of the extrahepatic cyst component. There were no surgical deaths. One patient with metastases was treated conservatively. Median follow-up was 6·5 years. Two of three patients who developed anastomotic strictures underwent successful revision surgery, while one with secondary sclerosing cholangitis developed biliary cirrhosis and died from hepatic failure after 8 years. Both patients with cholangiocarcinoma have died. Ten survivors are well and one patient was lost to follow-up. This study highlights the complexity of choledochal cysts in adults and emphasizes the need for earlier diagnosis and treatment. Cyst excision should be performed where possible, with reconstruction modified to deal with the cyst type as well as associated hepatobiliary pathology.
Improved outcome for children with hepatoblastoma
Authors: Stringer M D , Hennayake S , Howard E R , Spitz L , Shafford E A , Mieli-Vergani G , Saxena R , Malone M , Dicks-Mireaux C , Karani J , Mowat A P , Pritchard J 
Published: March 2007

Abstract
Between 1981 and 1993, 41 children were treated for hepatoblastoma. Clinical, radiological and pathological data were reviewed retrospectively, focusing on surgical aspects of treatment and outcome. Fourteen children underwent primary resection of the hepatic tumour. One infant with severe congenital anomalies received only palliative treatment. Of 26 with irresectable disease, pulsed cytotoxic chemotherapy (cisplatin and doxorubicin) enabled subsequent surgical excision in 22 and one child with persistent extensive intrahepatic disease was successfully treated by liver transplantation. Thus, with a policy of selective preoperative chemotherapy, 90 per cent of hepatoblastomas were resectable. There were no perioperative deaths from haemorrhage but one child died from an intraoperative tumour embolus. A total of 28 survivors, 27 of whom are disease-free, were followed for a median of 5 years. The cumulative probability of survival in patients treated with intent to cure was 67 per cent. Analysis of survival data suggested a favourable outcome for those with a pure fetal histological tumour subtype. These results demonstrate significant progress in the treatment of hepatoblastoma.
Setons in the surgical management of fistula in ano
Authors: McCourtney J S , Finlay I G 
Published: March 2007

Abstract
Seton techniques have been used in the successful management of fistula in ano for thousands of years. In particular, the cutting seton is useful for complex high anal fistula, and drainage setons may have a significant role in the treatment of sepsis related to Crohn's disease and in immunocompromised patients.
Enhanced intra-anastomotic healing by operative lavage with nutrient solutions in experimental left-sided colonic obstruction
Authors: Aguilar-Nascimento J E , Mathie R T , Man W K , Williamson R C N 
Published: March 2007

Abstract
The influence of intraoperative lavage with various solutions was tested on the healing of experimental colonic anastomoses performed in the presence of obstruction. After 24 h of ligature obstruction to the pelvic colon, male Wistar rats (n = 108) underwent colonic resection and primary anastomosis, using lavage with one of four different fluids: saline, povidone-iodine, 10 per cent hypertonic glucose and short-chain fatty acids (SCFA). Controls had no lavage. The anastomotic segment was excised and studied after 3 or 6 days. At day 3, mean(s.d.) bursting pressure was significantly greater in animals receiving SCFA compared with controls (81.2(23.0)mmHg versus 34.8(34.0)mmHg). Mean(s.d.) bowel wall tension was higher in rats with SCFA (30.6(8.1) N/m × 10−4) or hypertonic glucose (29.5(10.1) N/m × 10−4) compared with controls (12.2(12.1) N/m × 10−4). By day 6, the anastomosis was more resistant to intraluminal pressure in each lavage group; mean(s.d.) hydroxyproline concentration at the anastomosis was greater in rats with SCFA (12.4(1.5) μg/mg) or hypertonic glucose (11.6(2.9) μg/mg) than in controls (8.9(1.5)μg/mg). Anastomotic healing is improved by all types of intraoperative colonic lavage, particularly with SCFA and hypertonic glucose solutions.
Abdominal aortic aneurysm in the Irish population: A familial screening study
Authors: Fitzgerald P , Ramsbottom D , Burke P , Grace P , McAnena O , Croke D T , Collins P , Johnson A , Bouchier-Hayes D 
Published: March 2007

Abstract
A pilot screening programme was undertaken in Ireland to determine the incidence of abdominal aortic aneurysm (AAA) (diameter 3 cm or greater) in the siblings of 120 patients known to have AAA. There were 621 siblings; 270 of them were dead, 32 were over 80 years old and 85 lived outside Ireland, leaving 234 under 80 years of age still living in Ireland who were invited to attend for ultrasonographic screening. Of the 270 siblings who had died, 102 were women and 168 men; eight men (4.8 per cent) had died from ruptured AAA. Only 125 (53.4 per cent) of the 234 siblings agreed to participate in the screening programme, 60 brothers from 31 families and 65 sisters from 35 families. Fifteen (12.0 per cent) of the 125 siblings had an AAA (median size 4.2 (range 3.1–6.8) cm), 13 (22 per cent) of the 60 male siblings and two (3 per cent) of the 65 female siblings. The prevalence of AAA among siblings was not affected by the age or sex of the patient with aneurysm. Seven of the 14 male siblings with hypertension had an AAA, compared with only six of the 46 who were normotensive (P = 0.01). The high incidence of AAA in brothers of affected patients highlights the need to counsel this group on their risk of aneurysm. The relatively low participation rate by siblings in this screening programme indicates that a hospital-based unit is unlikely to be effective in recruiting all patient siblings at risk from an AAA.
Penetrating injuries of the femoral artery
Authors: Degiannis E , Levy R D , Velmahos G C , Potokar T , Saadia R 
Published: March 2007

Abstract
This is a retrospective study of 106 patients with penetrating injuries to the femoral artery. The cause of injury was gunshot in 82 per cent, stabbing in 13 per cent and pellets in 5 per cent. We believe that angiography is unnecessary in patients with ‘hard’ signs of vascular injury: 97 patients underwent immediate exploration with positive findings. The presence of ‘soft’ signs alone mandates angiography as five of 12 patients with suspected injury were saved a negative exploration. Proximity of injury was a poor predictor of arterial injury. There were four amputations. Ligation of the femoral vein is not reliably associated with amputation but it was an aggravating factor in the setting of severe arterial disruption and delay to surgery.
Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 Xal units in 2070 patients
Authors: Bergqvist D , Burmark U S , Flordal P A , Frisell J , Hallböökr T , Hedberg M , Horn A , Kelty E , Kvitting P , Lindhagen A , Ljungström K G , Mätzsch T , Risberg B , Syk I , Törngren S , Wellander E , Örtenwall P 
Published: March 2007

Abstract
The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 Xal units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 Xal units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P &lt; 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P &lt; 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P &lt; 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 Xal units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 Xal units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.
Endoscopically guided surface repair of inguinal hernia
Authors: Darzi A , Bouchier-Hayes D , Menzies-Gow N , Nduka C C 
Published: March 2007

Abstract
A novel tension-free prosthetic mesh repair for inguinal hernia is described. This is performed through 2-cm groin incision and the inguinal canal is traversed with the aid of a 5-mm videoendoscope. Spermatic mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic guidance. Between October 1993 and January1994, 22 primary unilateral hernia, and two bilateral repairs were undertaken. The mean (range) age was 47 (35–64) years in 23 men and one woman. The mean (range) operative time was 42 (35–58) min. All patients left hospital on the day after surgery. One patient developed a scrotal swelling that required a scrotal support.
Increasing incidence and changing presentation of thyroid cancer over a 30-year period
Authors: Fahey T J , Reeve T S , Delbridge L 
Published: March 2007

Abstract
During a 30-year period 8561 thyroidectomies were performed and 660 new patients presented with thyroid cancer. The number of thyroidectomies performed annually remained relatively constant for the past 20 years but the annual incidence of thyroid cancer increased from two patients in 1963 to 60 in 1992. Possible contributing factors include: altered referral patterns as a result of the introduction of fine-needle aspiration biopsy; an increase in the incidence of occult papillary cancer as a result of performing total thyroidectomy for multinodular goitre; and a background increase of thyroid cancer in the population. Data from the New South Wales State Cancer Registry implicate a background increase in the incidence of thyroid cancer in the population as a major contributing factor.
Paraoesophageal hiatus hernia: An important complication of laparoscopic Nissen fundoplication
Authors: Watson D I , Jamieson G G , Devitt P G , Mitchell P C , Game P A 
Published: March 2007

Abstract
Postoperative paraoesophageal hiatus hernia occurred in 17 of 253 patients who underwent laparoscopic fundoplication at five different hospitals. Ten patients have undergone subsequent surgical revision, eight by an open technique and two by laparoscopy. This complication may have important implications for the technique of laparoscopic fundoplication, as it is possible that routine posterior repair of the diaphragmatic hiatus may greatly reduce the risk. Early postoperative contrast radiology may also achieve earlier diagnosis, enabling correction to be undertaken by laparoscopy.
Prospective audit of perforation rates following upper gastrointestinal endoscopy in two regions of England
Authors: Quine M A , Bell G D , McCloy R F , Matthews H R 
Published: March 2007

Abstract
After cardiopulmonary complications, perforation is the second most important cause of complications following flexible upper gastrointestinal endoscopy. A recent audit of 14149 procedures detected a perforation rate of 0.05 per cent (overall mortality rate 0.008 per cent) during diagnostic endoscopy, and a perforation rate of 2.6 percent (overall mortality rate 1.0 per cent) following oesophageal intubation or dilatation. The incidence of perforation following both diagnostic and therapeutic upper gastrointestinal endoscopy has not changed over the past 10 years. The risk factors are numerous but this audit demonstrated that inexperience increases the likelihood of perforation.
Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed haemorrhoids
Authors: Ho Y H , Seow-Choen F , Goh H S 
Published: March 2007

Abstract
The effect of haemorrhoidectomy on rectal and anal physiological abnormalities was studied in 24 consecutive patients (12 men and 12 women of mean(s.e.m.) age 39.1(2.4) years) and compared with results in 13 sex- and age-matched controls. Before operation those with haemorrhoids had significantly higher resting anal pressures (P &lt; 0.005), lower rectal compliance (P &lt; 0.05) and more perineal descent (P &lt; 0.05). Following haemorrhoidectomy there were significant decreases in the maximum resting (P &lt; 0.05) and maximum squeeze anal (P &lt; 0.001) pressures to within normal values 3 months after operation. Rectal compliance also increased significantly (P &lt; 0.05), to that of normal controls. The abnormalities found in patients with prolapsed piles reverted to the normal range within 3 months of haemorrhoidectomy. These physiological changes are therefore more likely to be an effect, rather than the cause, of enlarged anal cushions.
Ileostomy output in the early postoperative period
Authors: Tang C L , Yunos A , Leong A P K , Seow-Choen F , Goh H S 
Published: March 2007

Abstract
The high volume output of a defunctioning loop ileostomy after rectal excision and anastomosis may lead to severe dehydration and electrolyte imbalance if not properly managed. Although chronic losses may be seen, the early postoperative period remains the most hazardous with regard to acute fluid and electrolyte losses for the patient with a defunctioning ileostomy1–3. A prospective study was therefore conducted to determine the period and severity of excessive ileostomy loss.
Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease
Authors: Elsman B H P , Legemate D A , van der Heijden F H W M , de Vos H J , Mali W P Th M , Eikelboom B C 
Published: March 2007

Abstract
Ultrasonographic duplex scanning has become a valuable diagnostic technique in detecting and grading stenoses and occlusions of the aortoiliac and femoropopliteal arteries. However, the question remains as to whether a treatment strategy can be designed without diagnostic angiography. This prospective study evaluated the impact of duplex scanning on therapeutic decision making. Patients with intermittent claudication, rest pain or ischaemic ulceration of the lower limb who were eligible for invasive treatment were studied. If treatment was considered necessary, a duplex scan was performed instead of diagnostic angiography. The surgeon made a therapeutic decision based on clinical assessment and information obtained from the duplex scan. If it was felt that duplex scanning gave insufficient information, diagnostic angiography was then performed. A group of 112 consecutive patients were studied prospectively; 12 were excluded for logistical reasons. The 100 remaining patients (intermittent claudication in 69, rest pain in 16, ischaemic ulceration in 15) were evaluated. Based on non-invasive tests 22 patients were treated conservatively, 36 were scheduled for percutaneous transluminal angioplasty (PTA) and 32 were scheduled for surgery. Angiography was requested to determine the definitive treatment policy in 28 patients: four of the 22 were scheduled for conservative treatment and 24 of the 32 were scheduled for surgery. All PTAs were performed without prior diagnostic angiography. Angiography was considered necessary in a further ten patients to formulate a therapeutic strategy. In 62 patients the treatment strategy could be determined without diagnostic angiography. Twenty-three of the 39 angiograms performed did not give additional information on treatment strategy. Integrated use of duplex scanning for the investigation of patients with arterial occlusive disease of the lower limb can reduce the need for diagnostic angiography.