bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total gastrectomy and oesophagojejunostomy with linear stapling devices
Authors: Walther B S , Zilling T , Johnsson F , Staël von Holstein C , Joelsson B 
Published: March 2007

Abstract
When performing total gastrectomy and oesophagojejunostomy with a circular stapling device two disadvantages are obvious; firstly, a purse-string suture is needed, and secondly the instrument can be extremely difficult to introduce if the oesophagus is narrow, so that the risk of rupture is substantial. We therefore developed the following technique. When the specimen is attached only to the oesophagus and the Roux-en-Y loop has already been divided with a linear stapling device, a small incision is made on the back wall of the oesophagus and antimesenterically 6 cm distal to the cut end of the Roux-en-Y loop. The two forks of the GIA® or the PLC 50® instrument are introduced into the oesophagus and jejunum, and the two organs are brought together at the hiatus. The instrument is closed and fired. The residual opening is closed with a linear stapler which also includes the front wall of the oesophagus. With a knife, the oesophagus and excessive amounts of tissue are trimmed away, and the oesophagojejunostomy is completed. Fifteen patients (median age 67 years) had a postoperative hospital stay of 10 days (range 8–45 days) after this operation. Leakage occurred in one patient and one patient died. The anastomosis took 12 min to perform (range 8–20 min). Three reoperations were needed: intestinal obstruction, leakage and a negative exploration. The median width of the oesophagojejunal anastomosis 6 months after operation was 32 mm (range 27–40 mm). Oesophagojejunostomy performed with two linear staplers allows a quick and reliable anastomosis independent of oesophageal lumen size and a time-consuming purse-string suture.
Changing patterns in gastric adenocarcinoma
Authors: Kampschöer G H M , Nakajima T , van de Velde C J H 
Published: March 2007

Abstract
A retrospective study was performed on gastric cancer patients admitted to the Cancer Institute Hospital, Tokyo, during the periods 1961–65 (n = 1181) and 1980–84 (n = 1473). The aim of the study was to see whether changes had occurred in gastric cancer patients over the years with respect to histology and tumour localization and, if so, how they compared with reports from the West. The proportion of proximally localized primary tumour increased from 17 to 27 per cent (P = 0·008), and signet-ring cell carcinoma increased from 2 to 22 per cent (P &lt;0·001). These changes were not relative with regard to the declining incidence of intestinal tumours, but absolute. Patients with proximally localized tumours were generally in a more advanced stage of disease than those with distally localized tumours, and thus had poorer survival rates. However, after stratifying into stages, the difference in survival disappeared. The survival rate of patients with signet-ring cell carcinoma was not significantly different from that of patients with other gastric tumours (P &gt;0·05). The discrepancy between the survival rates of Japanese and western gastric cancer patients is attributed by some authors to tumour-related factors. However, we believe that the similar trends found with regard to tumour localization and histology point towards comparable tumour behaviour in the two different geographical areas.
Emergency subtotal oesophagectomy
Authors: Matthews H R , Mitchell I M , McGuigan J A 
Published: March 2007

Abstract
From 1981 to 1987 nine patients have undergone resection and reconstruction of the oesophagus as an emergency, using a two-part left-sided approach with oesophagogastric anastomosis in the neck. Five patients had oesophageal perforation with a carcinoma; one had spontancous perforation of an intrathoracic stomach: two had severe haemorrhage; and one had acute sterile mediastinitis. Following operation there was one postoperative death (11 per cent) and no major complications. Long-term survival was marred only by the development of further malignancy in four patients. Subtotal oesophagectomy has both theoretical and practical advantages over conventional oesophagogastrectomy in oesophageal emergencies and we suggest that it should be considered as the method of choice in the management of these difficult cases.
Laser angioplasty with a pulsed NdYAG laser: Early clinical experience
Authors: Michaels J A , Cross F W , Shaw P , Raphael M , Bowker T J , Bown S G , Adiseshiah M , Marston A 
Published: March 2007

Abstract
Since December 1986, 40 laser angioplasty procedures have been performed using the energy from a pulsed NdYAG laser, delivering near infrared light (1064 nm) in 100-μs pulses of approximately 300 mJ per pulse, directly through a transparent sapphire tipped device. All patients had total occlusion of the superficial femoral artery and symptoms severe enough to warrant surgery, with ulceration or gangrene in eight, rest pain in 14 and severe claudication interfering with life-style in the others. The device was introduced through an antegrade puncture of the superficial or common femoral artery and laser recanalization was followed by attempted balloon angioplasty in all cases. Occlusions were a median length of 15 cm (range 2–35 cm); ten patients had previously undergone failed attempts at conventional balloon angioplasty and four had occluded femoropopliteal grafts. Thirty-seven legs of 34 patients were treated with an average of 60 J (range 10–235 J) with successful recanalization in 27 and immediate reocclusion in seven. The 20 successful recanalizations have been followed up for up to 24 months (median 7 months) with only one late occlusion at 5 months. Failed recanalization was due to poor transmission by the delivery device in the early part of the series (five cases), repeated passage of the device down a collateral branch (four cases), dissection at the site of previous surgery (two cases) or no apparent reason (two cases). Immediate reocclusion was due to very poor run off in patients with severely ischaemic limbs (three cases) or technical difficulties with balloon dilatation (two cases). Complete symptomatic relief was obtained in all the cases of radiologically successful laser angioplasty. Early surgery was required in one case following reocclusion of the artery when an angioplasty balloon failed to deflate, and one patient suffered a skin reaction thought to be due to inadequate removal of the sterilizing solution. A different sterilizing procedure is now followed. Laser angioplasty can reduce the number of patients requiring bypass surgery and improvements in the device and access methods may reduce the number of untreatable cases.
Operative assessment of femorodistal bypass grafts using a new Doppler flowmeter
Authors: Beard J D , Scott D J A , Skidmore R , Baird R N , Horrocks M 
Published: March 2007

Abstract
Operative measurements using a newly developed Doppler flowmeter were made on 47 in situ femorodistal bypass grafts performed for critical ischaemia. Graft blood flow, peripheral resistance and impedance were measured before and after the injection of 15 mg papaverine down the graft. The proportion of retrograde blood flow at the distal anastomosis was also measured. The success of a graft at 1 month was defined by patency on duplex ultrasound scanning, a rise in the Doppler ankle pressures and an improvement in the clinical state of the limb. By these criteria the 1-month primary success rate was 35 out of 47 (74 per cent). Graft blood flow was of little value in predicting graft outcome but, combined with segmental pressures, accurately located six of eight technical problems which were successfully corrected. After papaverine, the peripheral resistance of all the successful grafts fell below one peripheral resistance unit (PRU). No single measurement was able to completely distinguish between success and failure, although discriminant analysis of all measurements was able to predict success with a sensitivity of 100 per cent and specificity of 97 per cent. A simpler combination of a peripheral resistance after papaverine &lt;1 PRU and a retrograde blood flow &lt;33 per cent predicted success, with a sensitivity of 97 per cent and specificity 83 per cent. These criteria have been validated on a further 26 grafts, achieving a sensitivity of 88 per cent and a specificity of 75 per cent. Simple operative measurements, using a newly developed Doppler flowmeter, enable the detection of technical problems and the accurate prediction of the early outcome of femorodistal grafting.
Evaluation of non-invasive and invasive methods in the assessment of short saphenous vein termination
Authors: Vasdekis S N , Clarke G H , Hobbs J T , Nicolaides A N 
Published: March 2007

Abstract
Surgery of the short saphenous vein is associated with a high recurrence rate because of variations in the anatomy or inadequate clinical examination. To prevent this, accurate definition of the pattern and level of termination of the saphenopopliteal junction and flush ligation is necessary. Clinical examination, Doppler ultrasound, duplex scanning and peroperative venography have been compared to assess the level of termination of the short saphenous vein. In all, 64 limbs of 46 patients were examined. In 39 limbs there was primary short saphenous incompetence, in 13 limbs there was recurrent short saphenous incompetence; in ten of these there was incompetence of the gastrocnemius vein. In 12 limbs a duplex scan did not demonstrate incompetence of the short saphenous vein or gastrocnemius vein. The accuracy of these methods when locating incompetence of the short saphenous vein to within 2 cm of the saphenopopliteal junction was 56 per cent for clinical examination, 64 per cent for Doppler ultrasound and 96 per cent for duplex scanning. When there was no saphenopopliteal junction (9 per cent). duplex scanning correctly detected the pattern of the incompetent vein. The apparent success of clinical examination was because the vein was not felt above the femoral intercondylar groove and 52 per cent of the veins terminated at this level. Duplex scanning is a non-invasive technique which is almost as accurate as venography and provides additional haemodynamic information about the incompetent veins by demonstrating the presence and extent of reflux.
Role for prazosin in reducing the development of rabbit intimal hyperplasia after endothelial denudation
Authors: O'Malley M K , McDermott E W M , Mehigan D , O'Higgins N J 
Published: March 2007

Abstract
Intimal hyperplasia is the universal response to endothelial denudation and occurs after a variety of vascular procedures. In a proportion of cases the smooth muscle cell proliferation may lead to stenosis of the blood vessels. These vessels exhibit increased sensitivity to noradrenaline that can be reduced by the α1-adrenergic antagonist prazosin. Because the α1-adrenergic receptor and platelet-derived growth factor (which promotes vascular smooth muscle cell proliferation) act through the same metabolic pathway, it was postulated that α1-adrenergic blockade might reduce the development of intimal hyperplasia. Twenty-eight New Zealand White rabbits underwent endothelial denudation of the aorta using a Fogarty balloon catheter. Test rabbits were treated with prazosin from the day of operation until they were killed. All rabbits were killed either 1 or 4 weeks after endothelial denudation. Intimal hyperplasia in cross-sections of the aorta was measured using an X — Y digitizer and was standardized in terms of percentage luminal reduction. Prazosintreated rabbits had significantly less luminal reduction at 1 week (0·75(1·8) versus 9·7(3·1) per cent, mean (s.d.), P &lt;0·001) and at 4 weeks (14·7(4·4) versus 25·3(12·8) per cent, P &lt;0·05) than control rabbits. It is concluded that prazosin caused a major reduction in the development of intimal hyperplasia.
Totally stapled abdominal restorative proctocolectomy
Authors: Kmiot W A , Keighley M R B 
Published: March 2007

Abstract
A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a 20 × 20 cm J pouch and a stapled ileoanal anastomosis. The stapled ileoanal anastomosis had to be abandoned in three patients because of attempted mucosectomy in one and megarectum in two. One patient receiving steroids had a covering ileostomy. The remaining 16 patients had a totally stapled procedure without a covering ileostomy. Three patients developed serious postoperative morbidity but they were the only patients receiving steroids at the time of the operation. Of the remaining 13 patients none developed serious complications, the median hospital stay was 14 days and the median operating time was 150 min. The operation may be a technical advance particularly in allowing pouch construction without ileostomy in fit patients who are not receiving steroids at the time of operation.
Obstructing carcinomas of the colon
Authors: Serpell J W , McDermott F T , Katrivessis H , Hughes E S R 
Published: March 2007

Abstract
A series of 908 cases of colonic carcinoma has been analysed to elucidate reasons for the poor prognosis in obstructing colonic cancer. Complete obstruction was present in 148 cases (16·3 per cent), 280 cases (30·8 per cent) had partial obstruction and 480 (52·8 per cent) presented without obstruction. There were fewer Dukes' A tumours in those with complete obstruction (P &lt;0·005) and greater numbers of advanced tumours (P &lt;0·0005) compared with those without obstruction. This is reflected in a lower curative resection rate of 50·7 per cent in those with obstruction compared with 70·6 per cent in those without obstruction (P &lt;0·001). However, after curative resection there was no significant difference in the distribution of tumour stage. Patients with complete obstruction showed a higher incidence of recurrence (P &lt;0·01) after curative resection, consequent to an increased incidence of local recurrence (P &lt;0·02). Five-year cancer-specific survival for the total series was decreased from 59·1 per cent in patients without obstruction to 31·8 per cent in those with complete obstruction (P &lt;0·001). After curative resection there was also a significant reduction in survival (P &lt;0·001). It is concluded that completely obstructing colonic cancers are more aggressive than other colonic cancers.
Anal canal mucosa in restorative proctocolectomy for ulcerative colitis
Authors: King D W , Lubowski D Z , Cook T A 
Published: March 2007

Abstract
In an attempt to improve continence after restorative proctocolectomy, ileal reservoir-anal anastomosis at the level of the anorectal junction has been advocated. This procedure preserves the entire mucosa of the anal canal. The histological appearances of the anal mucosa have been examined in 16 consecutive patients undergoing restorative proctocolectomy for ulcerative colitis. In 14 patients there was chronic inflammation characteristic of ulcerative colitis. Four patients had moderate dysplasia and in one of these patients an unsuspected adenocarcinoma of the anal canal extending down to the level of the dentate line was present. We believe that the anal mucosa should always be removed down to the level of the dentate line in restorative proctocolectomy for ulcerative colitis.
Role of dietary restriction in Haemoccult® screening for colorectal cancer
Authors: Thomas W M , Pye G , Hardcastle J D , Chamberlain J , Charnley R M 
Published: March 2007

Abstract
The aim of this study was to investigate the effect of dietary restrictions on the positivity rate and yield of neoplasia during a study based on Haemoccult® screening for colorectal neoplasia. Of 18925 participants who completed Haemoccult tests on a normal diet, 647 (3·4 per cent) were positive. All repeated the test with dietary restrictions: 251 remained positive and underwent further investigations which revealed 35 carcinomas and 169 adenomas in 129 subjects. The remaining 396 were sent a further Haemoccult test at 3 months. Of these, 317 (80·1 per cent) completed the test: 31 (9·8 per cent) were positive. Further investigation of the 31 positive subjects revealed four carcinomas and 20 adenomas. Retesting with dietary restriction will reduce the false positive rate of Haemoccult when used for colonic cancer screening. However, if the retest is negative a further test should be performed. To minimize the adverse effect this may have on compliance, we have allowed an interval of 3 months to elapse before this retest is requested.
Acute primary hyperparathyroidism: Experience of 59 cases
Authors: Sarfati E , Desportes L , Gossot D , Dubost C 
Published: March 2007

Abstract
Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.
Reducing renal injury during transplantation
Authors: Forsythe J L R , Dunnigan P M , Proud G , Lennard T W J , Taylor R M R 
Published: March 2007

Abstract
Damage sustained by an ischaemic kidney is reduced by cooling the organ. For this reason kidneys are rapidly cooled during the retrieval operation and preserved at low temperature before implantation. When the kidney is removed from cold storage for implantation into the recipient it gradually rewarms (second warm ischaemic time) and a prolonged second warm ischaemic time has been shown to be a cause of acute tubular necrosis following transplantation. The temperature rise in a kidney during implantation has been poorly investigated and little work to minimize that rise has been carried out. This study investigates, in an animal model, the changes that occur in the core temperature of kidneys during the second warm ischaemic time. A jacket has been designed which greatly reduces the rate of kidney rewarming during simulated operative conditions. Kidneys unprotected by the test system showed a rapid rise in temperature from a mean of 1°C to a mean of 20° C after 45 min, compared with those kidneys placed in the protective jacket in which the temperature rose to a mean of only 8° C in the same time. The jacket is not bulky and is simple to use. Maintaining a low kidney core temperature during the second warm ischaemic time will reduce injury to the kidney and should be part of routine clinical practice.
Skin cancer in renal transplant recipients
Authors: Liddington M , Richardson A J , Higgins R M , Endre Z H , Venning V A , Murie J A , Morris P J 
Published: March 2007

Abstract
Skin cancer was found in 31 of 598 patients transplanted in Oxford. No cases occurred during the first 3 years after transplantation but the prevalence rose after 12 years to 18.2 per cent. The main risk factors predisposing to skin cancer were the time after transplantation and male sex. Comparison with data from other centres suggests that exposure to ultraviolet light is a major aetiological factor in the speed of development of skin cancer. As the incidence of new cases rose progressively with time in our patients, it would seem that skin cancer is likely to become a major clinical problem as more patients enjoy prolonged survival after renal transplantation. Preventative and screening measures should be taken by transplant units both in the UK and in other countries with similar temperate climates.
Clinical decision making and laparoscopy versus computer prediction in the management of the acute abdomen
Authors: Paterson-Brown S , Vipond M N , Simms K , Gatzen C , Thompson J N , Dudley H A F 
Published: March 2007

Abstract
A prospective study has been undertaken of 321 patients with acute abdominal pain admitted to hospital under one surgical firm over a period of 21 months. During the first 10 months patients were classified on admission according to the perceived need for operation, with laparoscopy being performed on all those in whom the need for operation was uncertain. In addition, all women with suspected appendicitis underwent laparoscopy because previous studies by us and others have demonstrated a high error rate in this group. During the second 11 months of the study a similar system of classification and procedure was used but the patient's initial assessment was entered on a structured data sheet. After the patient had been discharged home this information was entered into a computer-aided diagnosis program. Hypothetical retrospective computer-aided decisions were then made about patient management. The final management error rate (correct decision to operate or not) was compared with the actual error rate using the clinical system. The final overall error rate in the first 10 months was 11 out of 163 patients and this was improved to 3 out of 158 in the second 11 months of the study by the addition of the structured data sheet to selective laparoscopy. A management policy based entirely on diagnostic probabilities taken from the computer-aided diagnosis program would have produced an error rate of 26 out of 158. We conclude that in the management of the acute abdomen a policy based on clinical decision combined with selective laparoscopy may be superior to one based on diagnostic probabilities alone. Further improvement in results follows the introduction of a structured data sheet for initial data collection.
Cryotherapy for liver metastases: A new approach
Authors: Charnley R M , Doran J , Morris D L 
Published: March 2007

Abstract
A new system designed for cryosurgery of liver metastases is described. The cryoprobe, which utilizes circulating liquid nitrogen and produces a spherical iceball around each metastasis, is controlled by operative ultrasound. There was nor mortality and all patients left hospital within 10 days. Cryotherapy produced an area of destruction within the liver substance which decreased in size by 6 weeks as shown on serial computed tomographic scanning.
Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: A prospective study
Authors: Khawaja H T 
Published: March 2007

Abstract
Thirty-seven patients with previously untreated perianal condylomata acuminata were randomly treated by application of 25 per cent podophyllin or scissor excision. The result of treatment was assessed by an independent observer. At 6 weeks, scissor excision completely cleared the warts from 16 of 18 patients (89 per cent) compared with 15 of 19 patients (79 per cent) treated with podophyllin. Following complete clearance by surgery, two patients had recurrent warts at 18 weeks and a further single patient at 42 weeks, giving a cumulative recurrence rate of 19 per cent. In contrast, five of 15 patients whose warts were cleared by podophyllin had recurrent warts at 18 weeks and a further four at 42 weeks representing a cumulative recurrence rate of 60 per cent (χ2 = 3.95, d.f. = 1, P = 0.05). At 42 weeks six patients (32 per cent) were free of disease in the podophyllin group compared with 13 (72 per cent) in the scissor excision group (χ2 = 4.6, d.f.=1, P = 0.03). Scissor excision is therefore preferable to podophyllin application in the treatment of perianal condylomata acuminata.