bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of pancreatic pseudocysts
Authors: Andersson R , Janzon M , Sundberg I , Bengmark S 
Published: March 2007

Abstract
Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. The median cyst size was 10 cm (range 2–25 cm). Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. These patients had significantly smaller (median 4 cm) cysts compared with those in both percutaneously and surgically treated patients (P &lt; 0·01). In 22 patients the pseudocysts (median 9 cm) were punctured percutaneously under ultrasound guidance and the cyst fluid was aspirated or drained through a catheter. Complete resolution occurred in 13 patients after 1–4 (mean 2·8) punctures per patient, regression occurred in six patients after 1–4 (mean 2·0) puncture procedures per patient and three were unchanged. No complications were noted, except that two patients treated percutaneously required additional surgery. Thirty-seven patients were managed surgically (median cyst size 11 cm) with external drainage (12 patients), cystgast-rostomy (17 patients), cystduodenostomy (three patients) cystjejunostomy (three patients) and pancreatic resection (two patients). Resolution of the cyst was noted in 29 patients, regression in five and three were unchanged. Five patients required additional surgery. Twelve complications were seen in ten patients (27 per cent), most frequently after external drainage. One patient died after surgical treatment. Mean hospital stay was 13 days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. If surgery is required cystgastrostomy is preferred.
Management of screen detected ductal carcinoma in situ of the female breast
Authors: Carpenter R , Boulter P S , Cooke T , Gibbs N M 
Published: March 2007

Abstract
Thirty eight ductal carcinomas in situ of the female breast detected during the first 7 years of screening by the Guildford Breast Screening Unit have been treated by one surgeon. Twenty-eight cases were treated conservatively and ten by mastectomy. In the group treated conservatively there have been five local recurrences: four as ductal carcinoma in situ and one as node negative microinvasive carcinoma. There were no clinical or pathological features that predicted local recurrence, which was detected only by follow-up mammography. Based on these early results, an initially conservative approach to screen detected ductal carcinoma in situ is advocated.
Number and anatomical distribution of incompetent thigh perforating veins
Authors: Papadakis K , Christodoulou C , Christopoulos D , Hobbs J , Malouf G M , Grigg M , Irvine A , Nicolaides A 
Published: March 2007

Abstract
Although incompetent thigh perforating veins are considered to be a common cause of recurrence of varicose veins after high saphenous ligation, the number and distribution of such incompetent veins have not been reported. The aim of the study was to determine the number and anatomical distribution of incompetent thigh perforating veins. Sixty-five limbs in 48 patients with varicose veins who were found to have incompetent thigh perforating veins on ascending deep to superficial venography were studied. In 80 per cent of patients one incompetent thigh perforating vein was found and in 20 per cent more than one was found. Concomitant incompetent calf perforating veins were found in 92 per cent of the limbs studied. The incompetent thigh perforating veins were found to occur anywhere in the thigh, from the upper edge of the patella to a few centimetres below the saphenofemoral junction. The majority (71 per cent) were found in the middle third of the thigh. All incompetent thigh perforating veins were communicating with the long saphenous vein, including those in five patients with incomplete stripping. The surgeon should be aware of incompetent thigh perforating veins which may be multiple and occur at any site on the medial aspect of the thigh.
Clinical results of colectomy for severe constipation
Authors: Yoshioka K , Keighley M R B 
Published: March 2007

Abstract
Subtotal colectomy has been performed in 40 patients with severe constipation. Only one patient was male. Five patients (13 per cent) had a history of a serious psychiatric disorder. Twenty-six patients (65 per cent) could not expel a 100-ml air-filled balloon and 19 patients (48 per cent) had electromyographic evidence of abnormal puborectalls contraction during attempted defaecation before operation. Median preoperative passage of 50 radio-opaque markers over 5 days was 16 per cent. Sixteen patients had had a previous anorectal myectomy to exclude Hirschsprung's disease. Initial resections were subtotal colectomy and ileorectal anastomosis (n = 34), caecorectal (n = 5) or ileosigmoid (n = 1) anastomosis. Secondary operations included restorative proctocolectomy and ileal pouch—anal anastomosis (n = 6) and six patients eventually had an ileostomy. Median bowel frequency per week significantly increased after operation (0·3 (range 0–1) preoperatively to 21 (range 2–70) postoperatively, P &lt; 0·005), the percentage of patients with abdominal pain fell after operation from 93 to 39 per cent but symptoms of abdominal distension remained the same (86 per cent preoperatively and 82 per cent postoperatively).
Management of infection after prosthetic abdominal rectopexy (Wells' procedure)
Authors: Ross A H McL , Thomson J P S 
Published: March 2007

Abstract
The management and results of treatment of eight cases of implant infection after a Wells' rectopexy for rectal prolapse are reported. Most infections presented within 3 months of the rectopexy. Fever, abdominal or pelvic pain, diarrhoea, and the passage of pus per rectum were common presenting features. Removal of the infected implant per rectum or per vaginum was successful in four of five attempts and is the recommended initial approach, particularly in cases occurring early after surgery. Despite removal of the implant early after rectopexy recurrent prolapse did not occur.
Rehabilitation after lower limb amputation: A comparative study of above-knee, through-knee and Gritti—Stokes amputations
Authors: Houghton A , Allen A , Luff R , McColl I 
Published: March 2007

Abstract
A study of 169 unilateral amputees under three Disablement Services Centres was performed. The study comprised 88 above-knee, 54 through-knee and 27 Gritti-Stokes amputations. Satisfactory rehabilitation occurred in 33 per cent of above-knee, 62 per cent of through-knee and 44 per cent of Gritti—Stokes patients (56 per cent overall). The better rehabilitation of through-knee versus above-knee amputees (P &lt; 0·02) was also found in a group of patients matched for comparable age and duration of amputation as well as in a group of age-matched vascular amputees. Through-knee amputees relied significantly less on wheelchairs than above-knee (P = 0·016) and Gritti—Stokes (P = 0·05) amputees. The prosthesis used for the through-knee and Gritti—Stokes amputations was considered unsightly in 50 per cent of cases (versus 31 per cent for the above-knee prosthesis).
The superior rehabilitation with through-knee amputations should prompt us to improve both our technique for this amputation and the prostheses currently available. A through-knee amputation should be performed in preference to an above-knee amputation in the case where either is surgically possible, and a below-knee amputation not feasible.
Technical aspects of war wound excision
Authors: Coupland R M 
Published: March 2007

Abstract
Excision of war wounds may be performed by civilian surgeons with no previous experience of war surgery. The principles of complete excision of non-viable tissue with removal of foreign material, leaving the wound open, and delayed primary closure of skin are vitally important. A major part of the surgical approach is wound assessment and the formation of an operative plan. The extent and ease of the operation depends on the site, age and type of wound. Attention to the technique of wound excision avoids septic complications and permits skin closure when the first dressing is removed. Wounds may need re-excision at a later date. Modification of surgical management is necessary when certain difficult areas are wounded and when the patient presents after many days or has suffered inappropriate first aid.
Role of cholecystostomy in the management of critically ill patients suffering from acute cholecystitis
Authors: Winkler E , Kaplan O , Gutman M , Skornick Y , Rozin R R 
Published: March 2007

Abstract
Between the years 1976 and 1985, 60 patients underwent cholecystostomy for acute cholecystitis in the surgical department of the Rokach hospital in Tel Aviv. The patients' average age was 73 years; 78 per cent were 70 years or older at the time of operation. The decision to perform cholecystostomy was taken before the operation which was performed as an emergency procedure for patients considered to be at high risk for cholecystectomy. Forty-six patients (77 per cent) had severe concomitant diseases, and 42 per cent of them had two or more associated diseases simultaneously. The cardiac risk index was high in most patients (90 per cent). Fifty-two patients recovered promptly after surgery. Five patients (8 per cent) developed significant postoperative complications. Three other patients (5 per cent) died of cardiovascular complications. Forty-two patients (70 per cent) underwent an elective cholecystectomy 6–8 weeks later with no further morbidity or mortality. Eleven patients who were at high risk had no further surgery. No residual stones were found in these patients and no relapse of the disease was recorded in the long term follow-up. Four patients were lost to follow-up. We conclude that cholecystostomy may still be used as an initial life saving procedure for critically ill patients with acute cholecystitis, and serves as a definitive procedure for patients considered to be at very high operative risk and who have no residual stones.
Delayed recovery of hand grip strength predicts postoperative morbidity following major vascular surgery
Authors: Griffith C D M , Whyman M , Bassey E J , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Forearm muscle dynamometry was performed in the non-dominant arm in 61 patients undergoing major abdominal and limb vascular surgery, before operation and then 1, 3, 5, and 7 days after surgery. Six patients died in the postoperative period and seven patients developed major postoperative complications (bronchopneumonia, two; wound infection, four; myocardial infarction, one). The preoperative grip strength, measured in kilograms, of the patients who died after major vascular surgery was not significantly lower than that of patients who had an uncomplicated postoperative course. Of the 55 surviving patients, seven developed complications after surgery. These patients had significantly reduced grip strength, expressed as a percentage of the individual preoperative value (P &lt; 0·05), from the first to the seventh postoperative day when compared with patients without complications. The delayed recovery of grip strength preceded the clinical manifestation of complications. These data suggest that delayed recovery of voluntary muscle performance may be used to detect patients developing postoperative complications and so allow their early treatment.
Human thrombin plus 5 per cent ethanolamine oleate injected to sclerose oesophageal varices: A prospective randomized trial
Authors: Kitano S , Hashizume M , Yamaga H , Wada H , Iso Y , Iwanaga T , Sugimachi K 
Published: March 2007

Abstract
Fifty cirrhotic Japanese patients with oesophageal varices underwent sclerotherapy in a prospective randomized trial carried out to examine the effects of human thrombin given concomitantly with the sclerosant 5 percent ethanolamine oleate. The two groups (25 patients each) were comparable with regard to size of the oesophageal varices, and the aetiology and severity of the liver disease. Twenty-five patients, 13 and 12 in the thrombin + and - groups, respectively, had at least one episode of variceal bleeding. The remaining 25 were given prophylactic injections. There was a significantly lower rate of occurrence of bleeding from injection sites when the injection needle was removed at the initial session of sclerotherapy in the thrombin + group, where human thrombin was injected (0·2-0·3 ml, 100–150 units per injection) just before removal of the injection needle. Endoscopy at 1 week after the initial session showed a significantly (P &lt; 0·05) higher rate of disappearance of red colour signs on varices in the thrombin + group (96 per cent) than in the thrombin - group (72 per cent). Fibrin degradation product E-fraction (FDP-E) values increased 1 h, 1 day and 6 days after the initial session of sclerotherapy in the two groups. The rate of increase in FDP-E values 1 h after sclerotherapy was significantly larger (P &lt; 0·001) in the thrombin + than in the thrombin - group. There was no clinical sign of disseminated intravascular coagulation. Administration of human thrombin plus a sclerosant seems to be useful and efficacious, especially for patients with huge oesophageal varices.
Rigid endoscopy under general anaesthesia is safe for chronic injection sclerotherapy
Authors: Wilson R H , Campbell W J , Spencer A , Johnston G W 
Published: March 2007

AbstractInjection sclerotherapy for acutely bleeding oesophageal varices has been used in Belfast since 1958. However, a chronic injection sclerotherapy programme with rigid oesophagoscopy under general anaesthesia commenced only in 1979. So far, 82 patients have entered the programme; 57 patients had already received 73 acute injections before commencing chronic sclerotherapy. Subsequently, the 82 patients received 221 chronic injections plus a further 29 acute injections for rebleeding episodes which occurred during the programme. There were 24 Child's grade A patients, 23 B and 35 C; 48 per cent had alcoholic cirrhosis. Forty-eight patients achieved variceal obliteration with a mean of four injections. During the programme 24 patients experienced 42 acute bleeds. There were only two bleeding episodes within 1 week of a chronic injection and eight within 4 weeks. In the 8-year period there have been four early deaths. One occurred 17 days after a chronic injection and three followed acute injections required for rebleeding during the programme. There were 21 late deaths, mostly due to progressive liver failure, and none from rebleeding. We conclude that chronic injection sclerotherapy using rigid oesophagoscopy under general anaesthesia is both safe and effective.
Emergency orthotopic liver transplantation in two patients using one donor liver
Authors: Bismuth H , Morino M , Castaing D , Gillon M C , Declere A Descorps , Saliba F , Samuel D 
Published: March 2007

Abstract
Because of its anatomy, the liver can be divided into two hemilivers suitable for use as two grafts for liver transplantation. The line of division is the main scissure, giving the right hemiliver (segments 5–8) and the left hemiliver (segments 2–4). Segment 1 (caudate lobe) has to be resected. The vessels are divided between the two grafts: the vena cava remains on the right; on the left, the left hepatic vein is sutured into the vena cava of the recipient, which is retained intact. The left graft retains only the left branch of the portal vein, the bile duct and the hepatic artery. The right graft retains the portal trunk, the common bile duct and the right branch of the hepatic artery. This procedure was used for emergency grafting of two patients with fulminant hepatitis when only one donor was available. Both recipients recovered from coma and regained normal liver function. However, both died from causes not specifically related to the operative technique, one from multiple organ failure on the 20th day and the other from diffuse cytomegalovirus infection on the 45th day.
Timing of strangulation in adult hernias
Authors: McEntee G P , O'Carroll A , Mooney B , Egan T J , Delaney P V 
Published: March 2007

AbstractThis retrospective study aimed to determine why the incidence of strangulated hernias in adults remains high. Seventy-nine patients presented with clinical evidence of hernia strangulation which required urgent surgery during the period 1979–87. Forty-six patients (58 per cent) had noted a hernia present for at least 1 month before strangulation: 18 (23 per cent) had not reported it to their family doctor, 19 (24 per cent) were known by family practitioners or non-surgical medical personnel to have a hernia but had not been referred for surgical opinion, and nine (11 percent) had been previously assessed surgically with a view to elective repair. Of these nine, five were considered unfit, three were on waiting lists for operation and one had refused surgery. Thirty-two patients (40 per cent) presented primarily with strangulation within days of developing a hernia. The duration of hernia before strangulation in one patient was unknown. Although an unavoidable number of patients will continue to present with strangulation within days of developing a hernia, the overall incidence could be significantly reduced by greater public awareness of the risks of hernia strangulation and by a policy of immediate patient referral and prompt elective repair.
APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: Prognotic value and potential clinical applications
Authors: Schein M , Gecelter G 
Published: March 2007

Abstract
This study examined the prognostic value of the APACHE II scoring system in patients undergoing emergency operations for bleeding peptic ulcer. There were 96 operations for gastric ulcers and 58 for duodenal ulcers. The mean scores in survivors and in patients who died were 10.8 and 17.5 respectively. None of the 66 patients with a n APACHE II score &lt; 11 died, whiel the mortality rate in those scored &gt; 10 was 22 per cent. In patients scored &gt; 10 non-resective procedures carried less risk of mortality than gastectomy. The APACHE II score is useful when measuring the severity of the acute disease and predicting the outcome in these patients. If used in daily practice it may assist the surgeon in stratifying patients into a low-risk group (score &lt; 11) in which major operations are well tolerated and outcome is favourable and a high-risk group (scor &lt; 10) in which the risk of mortality is high and the performance of procedures of lesser magnitude isprobably more likely to improve survival.
Multivariate analysis of factors influencing the results of restorative proctocolectomy
Authors: Keighley M R B , Winslet M C , Flinn R , Kmiot W 
Published: March 2007

AbstractUnivariate and multivariate analyses have been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were nine failures requiring intubation, ileostomy or pouch excision. There was a significant association between failure and pelvic sepsis (P &lt;0·05, n = 8), endoanal mucosectomy (P &lt;0·05, n = 7), preservation of a long rectal cuff (P &lt;0·05, n = 5) and lack of experience with the operation (P &lt;0·05, n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, three are now known to have Crohn's disease. Functional outcome was significantly impaired in patients who developed pelvic sepsis (P &lt;0·01) or a postoperative fistula (P &lt;0·05), and who had an endoanal mucosectomy (P &lt;0·05). Success with ileoanal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.
Anal endosonography in the evaluation of perianal sepsis and fistula in ano
Authors: Law P J , Talbot R W , Bartram C I , Northover J M A 
Published: March 2007

Abstract
Anal endosonography has been performed in 22 patients with fistula in ano and perianal sepsis and compared with the operative findings. Using a special hard cone attachment to a radial 7 MHz probe the examination was well tolerated, rapid and generally accurate, detecting two unsuspected foreign bodies and all seven complicated fistula in ano preoperatively.
Clinicopathologic study of early stage esophageal carcinoma
Authors: Sugimachi Keizo , Ohno Shinji , Matsuda Hiroyuki , Mori Masaki , Matsuoka Hideo , Kuwano Hiroyuki 
Published: March 2007

Abstract
As part of a consecutive series of 370 patients who underwent subtotal esophagectomy because of carcinoma of the thoracic area of the esophagus, between January 1965 and July 1988, in the Second Department of Surgery, Kyushu University Hospital, 42 patients (11.4%) with early stage esophageal carcinomas confined to the intraepithelium, mucosa, or submucosa were studied clinicopathologically. Of these 42, 26 (61.9%) had symptoms; slight dysphagia or chest discomfort was the most common symptom. The remaining 16 (38.1%) had no subjective symptoms. Endoscopic examination proved to be more useful than barium studies. Lugol-combined endoscopy was most effective in detecting the presence and spread of small malignant lesions of the esophagus. At the time of surgery, six patients with submucosal carcinoma of the esophagus had lymph node metastasis, and five died of recurrence. Described herein are the diagnostic features, clinicopathologic characteristics, and long-term results of these 42 patients with early stage, and 328 patients with advanced, carcinomas of the esophagus, detected and surgically treated in our clinics.
Aids in the diagnosis of acute appendicitis
Authors: Hoffmann J , Rasmussen O Ø 
Published: March 2007

Abstract
Methods used to improve the accuracy of diagnosis of acute appendicitis are reviewed. Laparoscopy, barium enema, ultrasonography and computer assistance have all been shown to improve accuracy, but no one method is of proven superiority. Such diagnostic aids or intensive in-hospital observation must be used to reduce the 15–30 per cent negative laparotomy rate when acute appendicitis is suspected, without increasing the incidence of appendiceal perforation.
Hypoplasia of defunctioned rectum
Authors: Appleton G V N , Williamson R C N 
Published: March 2007

Abstract
The adaptive response of the large bowel to surgical defunction in man is essentially unknown, although in the rat there is progressive hypoplasia and a reduced propensity to experimental carcinogenesis. Mucosal biopsies were taken from the upper rectum completely defunctioned by a proximal stoma from 2 months to 5 years earlier in 11 patients and from 14 controls without abdominal operations or disease. Samples were established in organ culture and, after 16 h, crypt cell production rate (CCPR) was determined by a stathmokinetic technique. Crypt morphometry was also undertaken. CCPR in defunctioned large bowel was less than half that of controls: (mean (s.d.) 1.96 (0.68) versus 4.65 (0.54) cells crypt−1 h−1, P &lt;0.0001). Likewise, crypt length was 24 per cent lower (0.34 (0.05) versus 0.44 (0.04) mm, P &lt;0.0001) and crypt width was 38 per cent lower (0.04 (0.01) versus 0.07 (0.01) mm, P &lt;0.0001). Rectal defunction causes profound and persistent hypoplasia in man.