bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysm in The Netherlands
Authors: Akkersdijk G J M , van der Graaf Y , van Bockel J H , de Vries A C , Eikelboom B C 
Published: March 2007

Abstract
Information on surgery for non-ruptured and ruptured infrarenal abdominal aortic aneurysm (AAA) in all hospitals in The Netherlands in 1990 was obtained from the Dutch National Medical Registration Foundation. The operation rate in the population over the age of 50 years was 30·3 per 100000 for non-ruptured AAA and 16·8 per 100000 for ruptured aneurysm. The hospital operative mortality rate for non-ruptured AAA surgery was 6·8 per cent in 1289 patients and for ruptured aneurysm 43·6 per cent in 709. For non-ruptured AAA the mortality rate almost doubled per age group of 10 years, whereas the influence of age was less significant for ruptured lesions. The operative mortality rate for non-ruptured aneurysm in university hospitals exceeded that in other hospitals, but no difference was found for emergency surgery on ruptured AAA. Nationwide results give a more representative picture of the true mortality rate associated with operation for aortic aneurysm. Such data are important for planning future treatment strategy and for evaluating the efficacy of screening.
Splenic autotransplantation after splenectomy: Tuftsin activity correlates with residual splenic function
Authors: Zoli G , Corazza G R , D'Amato G , Bartoli R , Baldoni F , Gasbarrini G 
Published: March 2007

Abstract
This study set out to determine the relationship between splenic function (as assessed by the percentage of pitted red cells) and tuftsin activity, and to confirm the return of effective splenic function after splenectomy for trauma. Twenty-three patients (13 men) took part. Ten of mean age 48·5 (range 30–74) years had had the spleen removed for traumatic rupture and 13 of mean age 49·7 (range 23–66) years had undergone elective splenectomy. At the time of the study all patients had had the spleen removed a minimum of 1 year previously (mean 6·1 (range 1–15) years). Fifty healthy volunteers matched for sex and age were also studied. In each subject, residual splenic function was evaluated by counting the percentage of pitted red cells. Tuftsin activity was also determined. A highly significant negative correlation was found between pitted red cell percentage and tuftsin activity (rs = −0·80, P 0·001). Compared with healthy controls (mean 21·6 (range 13–37) per cent), tuftsin activity was significantly reduced both in patients who had undergone splenectomy for trauma (mean 4·4 (range 0·9) per cent; P &lt; 0·0001) and in those who had had elective splenectomy (mean 0; P &lt; 0·0001). Tuftsin activity was significantly (P &lt; 0·001) more depressed after elective than traumatic splenectomy. These data confirm a decrease in tuftsin activity following splenectomy and show that this deficit is significantly greater after elective than emergency removal. These observations confirm that residual splenic function is often present after traumatic splenectomy.
Influence of total colectomy on serum antineutrophil cytoplasmic antibodies in inflammatory bowel disease
Authors: Patel R T , Stokes R , Birch D , Ibbotson J , Keighley M R B 
Published: March 2007

Abstract
Perinuclear antineutrophil cytoplasmic antibodies (pANCAs) have previously been demonstrated in patients with various forms of vasculitis and more recently in those with inflammatory bowel disease (IBD) by an indirect immunofluorescence technique. Sera from 194 patients were tested for pANCAs: 101 with ulcerative colitis (43 with varying grades of disease severity, 19 after subtotal colectomy, 39 following restorative proctocolectomy), 40 with Crohn's disease, five with indeterminate colitis, 24 patients without IBD and 24 healthy volunteers (controls). The overall prevalence of pANCAs in patients with ulcerative colitis was 70·3 per cent (71 of 101). These antibodies were still present in 29 of 39 patients after restorative proctocolectomy, in whom the median follow-up after surgery was 2 years. All five patients who had pouchitis after restorative proctocolectomy were pANCA positive. By contrast, only ten of 40 patients with Crohn's disease had pANCAs, nine of whom had Crohn's colitis. No pANCAs were detected in Controls. These results show that pANCAs are more prevalent in colonic IBD, especially ulcerative colitis. The persistence of pANCAs in the sera for 2 years after restorative proctocolectomy suggests that the antigens are not fully eradicated and, therefore, that it is not just the colon that is targeted immunologically in ulcerative colitis.
Prognosis of elderly patients with large bowel cancer
Authors: Mulcahy H E , Patchett S E , Daly L , O'Donoghue D P 
Published: March 2007

Abstract
The effect of age on the presentation, diagnosis, management and survival of patients with colorectal cancer was studied prospectively in 512 patients admitted to a single institution. In all, 225 patients were aged 70 years or more and 287 less than 70 years. Older patients had a significant excess of emergency presentations (18 versus 11 per cent). Methods of diagnosis, proportion of curative operations performed, stage and histological grade were similar in the two age groups. The postoperative mortality rate was 6 per cent in the elderly group and 3 per cent in younger patients. The postoperative mortality rate rose to 15 and 12 per cent respectively in those undergoing emergency surgery. The relative 5-year survival rate standardized for age and sex was 52 per cent for older patients and 45 per cent for younger patients; for those undergoing curative surgery it was 68 and 59 per cent respectively. The behaviour of colorectal carcinoma changes little with age and, allowing for population mortality, age has no effect on the long-term survival of elderly patients with large bowel cancer.
Hypercoagulable states in patients with leg ischaemia
Authors: Ray S A , Rowley M R , Loh A , Talbot S A , Bevan D H , Taylor R S , Dormandy J A 
Published: March 2007

Abstract
Hypercoagulable states are found in up to 10 per cent of patients with a history of unexplained venous thrombosis. To investigate the prevalence in arterial thrombosis, thrombophilia screening was performed on 124 patients who had previously undergone lower-limb revascularization, 45 claudicants and 27 controls. Of the patients who had undergone revascularization 40 per cent had a hyper-coagulation abnormality (low levels of protein C, protein S and antithrombin III or presence of the lupus anti-coagulant) in comparison with 27 per cent of claudicants and 11 per cent of controls (P &lt; 0·01). Furthermore, patients who had suffered reocclusion after revascularization were significantly more likely to have a hypercoagulation abnormality than those who had not (P &lt; 0·05), even if the occlusion had occurred more than 6 months previously. Lupus anticoagulant was the abnormality most frequently detected and, like low protein C levels, was found only in patients with peripheral vascular disease. It appears that hypercoagulable states are common in patients with arterial disease and may predispose to failure of revascularization.
Platelet activation during hand vibration
Authors: Kent P J , Williams G A , Kester R C 
Published: March 2007

Abstract
The level of β-thromboglobulin, the circulating platelet aggregate ratio and platelet sensitivity to aggregation with adenosine 5′-diphosphate (ADP) and collagen were assessed in 12 control subjects, 16 patients with vibration white finger (VWF) and 15 patients with primary Raynaud's disease; this was done before and after a 1-min exposure to hand vibration. The β-thromboglobulin level increased significantly in controls, from a median (interquartile range) of 35·5 (22–47) to 47·5 (27–52) ng/ml, and in the VWF group from 44·0 (39–60) to 47·5 (42–109) ng/ml (P &lt; 0·005). Vibration had no effect on circulating platelet aggregate ratio in any group. The platelets of normal subjects tended to be more sensitive to aggregation with low-dose ADP (1 mmol/l) than those of patients with VWF or primary Raynaud's disease. Significant change occurred in the lag phase of the aggregation response to vibration in the control group at an ADP concentration of 2 and 5 mmol/l. These results indicate that intravascular platelet aggregation occurs as a result of exposure to vibration. Platelet sensitivity to aggregation with ADP may be decreased in patients with VWF or established Raynaud's disease.
Carotid endarterectomy in Great Britain and Ireland: Practice between 1984 and 1992
Authors: Murie J A , John T G , Morris P J 
Published: March 2007

Abstract
Of 356 questionnaires on carotid endarterectomy sent to all vascular surgeons in Great Britain and Ireland likely to undertake this procedure, 326 (92 per cent) were returned. Of those who replied 131 (40 per cent) performed at least one carotid endarterectomy in 1992; 57 (44 per cent) of these carried out ten or fewer operations and 74 (56 per cent) more than ten. The 131 surgeons were collectively responsible for 2628 operations in 1992, twice as many as were undertaken in either 1984 or 1989, years for which similar survey data are available. This sharp rise in the number of operations was accounted for by increased activity on the part of experienced operators, rather than any rise in the number of ‘occasional’ carotid surgeons. In 1992, although the neurologist remained a major source of patient referral, general practitioners (and others) were also referring patients in large numbers direct to the vascular surgeon; this represents a change in practice compared with previous years. Many of the technical aspects surrounding carotid endarterectomy remained unchanged over the years surveyed (1984, 1989, 1992) but by 1992 duplex scanning, intra-arterial (but not intravenous) digital subtraction angiography and transcranial Doppler ultrasonography had become established as clinically useful techniques.
Trends in vascular surgery since the introduction of percutaneous transluminal angioplasty
Authors: Pell J P , Whyman M R , Fowkes F G R , Gillespie I , Ruckley C V 
Published: March 2007

Abstract
Lower-limb percutaneous transluminal angioplasty (PTA) has been used increasingly over the past decade, either alone or in conjunction with arterial reconstructive surgery. However, its impact on operation rates has not been evaluated properly. Rates of vascular operations and PTAs performed per referral for peripheral arterial disease to the regional vascular service at The Royal Infirmary, Edinburgh, were calculated for the years 1986-1992. The overall rate of PTA for peripheral arterial disease increased ninefold over this period; that for critical ischaemia increased fivefold. Rates of aortic and femoral reconstruction for all peripheral arterial disease increased by 40 and 100 per cent respectively, but rates for critical ischaemia remained static. The major amputation rate rose by 47 per cent between 1986 and 1990, and thereafter reached a plateau. Increased use of PTA was not associated with a reduction in the number of vascular operations.
Outcome in patients who require renal support after surgery for ruptured abdominal aortic aneurysm
Authors: Gordon A C , Pryn S , Collin J , Gray D W R , Hands L , Garrard C 
Published: March 2007

Abstract
Over a 3-year period haemofiltration and dialysis was provided for 18 patients who developed renal failure after operation for ruptured abdominal aortic aneurysm (AAA). Four of the patients underwent operation elsewhere and were transferred when renal failure was diagnosed. The median duration of renal support in the 11 survivors was 24 days, while the seven patients who died received support for a median of 11 days. By 3 months after operation eight of the 11 survivors were independent of dialysis. Renal support was life saving in eight of 91 patients operated on in Oxford for ruptured AAA and reduced the 30-day operative mortality rate from a potential 47 per cent to an actual 38 per cent. Haemofiltration and haemodialysis for acute renal failure after surgery for ruptured aortic aneurysm is clinically justified and results in the long-term survival of most patients.
Venous function and clinical outcome following deep vein thrombosis
Authors: Milne A A , Stonebridge P A , Bradbury A W , Ruckley C V 
Published: March 2007

Abstract
The severity of post-thrombotic symptoms in 111 limbs (107 patients) with previous phlebographically proven deep vein thrombosis (DVT) was correlated with superficial and deep venous function as determined by foot volumetry (n = 90) and duplex ultrasonography (n = 62). The median delay between DVT and assessment was 8 (range 1–34) years. Symptoms were mild (group 1) in 31 limbs (28 per cent), moderate (group 2) in 41 (37 per cent) and severe (group 3) in 39 (35 per cent). There was no significant relationship between the site of DVT, or the time since DVT, and the severity of symptoms. Without tourniquet occlusion of superficial veins, limbs in group 3 had a significantly shorter half-refilling time than those in groups 1 and 2 (P = 0–01). Although a similar trend was observed after tourniquet occlusion of superficial veins, this was not statistically significant. There was no significant difference in the expelled volumes between the three clinical groups. On duplex scanning, deep and superficial venous reflux was detected in just over half of the limbs in each group. Eight patients had entirely normal scans and none of them had severe symptoms (P = 0·04). This study identifies a strong association between severe postphlebitic syndrome and venous reflux, such that it may be considered that venous reflux is necessary for the development of severe post-thrombotic symptoms. However, many patients with severe reflux have only mild symptoms and additional factors must therefore contribute to the development of severe postphlebitic syndrome.
Randomized trial of adrenaline injection and laser photocoagulation in the control of haemorrhage from peptic ulcer
Authors: Carter R , Anderson J R 
Published: March 2007

Abstract
Forty-nine consecutive patients with bleeding from peptic ulcers that would conventionally have required surgical intervention were randomized to receive endoscopic injection of adrenaline (1:10000) or laser photocoagulation. Patients were included only if they had a visible vessel at endoscopic examination. Five patients proceeded directly to surgery and, of the remaining 44, 21 received laser photocoagulation and 23 injection therapy. Haemostasis was achieved initially in all patients. There was one rebleed in the group of patients who received laser treatment and four in those treated by injection. All five patients underwent further endoscopic haemostasis according to the initial randomization. Haemostasis was again achieved in all cases, but the patient who had undergone laser treatment suffered recurrent haemorrhage after a further 48 h and subsequently died. Overall, one of the 21 patients receiving laser treatment died compared with none of the 23 injected with adrenaline. Injection of adrenaline achieves similar results to laser photocoagulation for bleeding peptic ulcer.
Endoscopic drainage of traumatic pancreatic pseudocyst
Authors: Funnell I C , Bornman P C , Krige J E J , Beningfield S J , Terblanche J 
Published: March 2007

Abstract
Pancreatic pseudocyst following trauma is usually caused by a major duct injury and may present late. The outcome of endoscopic treatment in five patients with post-traumatic pseudocyst is described. Diagnosis was made from 3 weeks to 1 year after injury by ultrasonography and computed tomography. A distinct bulge was visible in the stomach or duodenum using endoscopic retrograde cholangio pancreatography, and a cyst enterostomy was established with a knife or standard papillotome. Successful drainage was achieved without complications. One patient developed a recurrence, which was redrained endoscopically, but surgical intervention was required for persistent pain. Early results suggest that endoscopic drainage for selected pancreatic pseudocysts is feasible and safe.
Chemotherapy prolongs survival in inoperable pancreatic carcinoma
Authors: Palmer K R , Kerr M , Knowles G , Cull A , Carter D C , Leonard R C F 
Published: March 2007

Abstract
Forty-three patients with irresectable advanced pancreatic cancer were randomized to receive chemotherapy using a combination of 5-fluorouracil, Adriamycin and mitomycin or no chemotherapy. Groups were well matched with regard to age, extent of disease and performance status on entry. Chemotherapy was well tolerated and, although common, side-effects were usually mild. Psychological measurements based on the Hospital Anxiety and Depression score were made in 31 patients. These showed significantly less depression but not anxiety in the treated group immediately after randomization and following 2 months of chemotherapy. Median survival in the treated group was 33 (range 9–80) weeks compared with 15 (range 1–62) weeks in the untreated group (P &lt; 0·002). Chemotherapy should be considered in all patients presenting with advanced inoperable pancreatic cancer.
Intra-abdominal sepsis and survival after surgery for colorectal cancer
Authors: Varty P P , Linehan I P , Boulos P B 
Published: March 2007

Abstract
Of 361 patients who survived curative left colonic or sphincter-saving rectal resection for cancer, 44 developed significant postoperative intra-abdominal sepsis and 317 did not. The two groups were well matched for age, sex, site of tumour, Dukes stage, tumour differentiation and timing of operation. There was no significant difference in the 5-year overall actuarial survival rate (P = 0·25) or in the 5-year disease-free survival rate (P = 0·23). Stepwise regression analysis of prognostic variables including age, sex, site of tumour, Dukes stage, tumour differentiation, timing of operation, grade of surgeon and postoperative intra-abdominal sepsis identified Dukes stage, age at operation and tumour differentiation as predictors of survival. These results suggest that postoperative intraabdominal sepsis is not a prognostic factor for long-term survival in colorectal cancer as has been previously reported.
Pathogenesis of abdominal aortic aneurysm
Authors: MacSweeney S T R , Powell J T , Greenhalgh R M 
Published: March 2007

Abstract
The pathogenesis of abdominal aortic aneurysm involves many factors acting over time. However, destruction of elastin in the aortic wall is a key event that shifts the load produced by blood pressure on to collagen. This is exacerbated in the presence of hypertension. Smoking and age are further important factors, as is the site; elastic lamellae are relatively less common in the abdominal aorta. Once the shielding effect of elastin is lost, further dilatation and rupture of the aorta depend on the physical properties of the collagen present.
Laparotomy in patients infected with human immunodeficiency virus: Indications and outcome
Authors: Lowy A M , Barie P S 
Published: March 2007

Abstract
Four distinct disease processes account for the majority of surgically correctable intra-abdominal pathologies associated with human immunodeficiency virus (HIV) infection: cytomegalovirus infection, Kaposi's sarcoma, non-Hodgkin's lymphoma and mycobacterial infection. Affected patients may also develop acute cholecystitis and appendicitis with significant frequency. Thorough investigation, when possible, will obviate the need for laparotomy in most HIV-infected patients with abdominal symptoms and signs. In those who require surgical intervention, the outcome varies greatly according to the nature of the diagnosis.
Randomized placebo-controlled double-blind study of three aprotinin regimens in primary cardiac surgery
Authors: Bailey C R , Kelleher A A , Wielogorski A K 
Published: March 2007

Abstract
The serine proteinase inhibitor aprotinin significantly reduces postoperative blood loss in patients requiring cardiac surgery using cardiopulmonary bypass. This study compared two low-dose regimens with administration of high-dose aprotinin and a control protocol to determine whether the dose of aprotinin could be greatly decreased but still maintain efficacy after primary cardiac surgery. Some 100 patients were randomly assigned to one of four groups: control group (0·9 per cent saline placebo, n = 25); high-dose group (aprotinin 2 × 106 kallikrein inactivator (KI) units intravenous patient bolus and 0·5 × 106 KI units h−1 plus 2 × 106 KI units into pump prime, n = 25); prime group (aprotinin 2 × 106 KI units added to the pump prime, n = 24); and patient group (aprotinin 106 KI units intravenous patient bolus plus 106 KI units added to the pump prime, n = 26). Only patients from the high-dose and patient groups had reduced intraoperative blood loss, but patients from all three aprotinin-treated groups demonstrated a significant decrease in median postoperative blood loss compared with the control group (high-dose 350 ml, prime 420 ml, patient 340 ml versus control 780 ml; P &lt;0·001). There was an even greater reduction in measured median postoperative haemoglobin loss within the chest drains in the treated compared with the control patients (high-dose 15 g, prime 24 g, patient 14 g versus control 47 g; P &lt;0·001). These decreases were statistically the same for all the treated groups; it is possible to lower the dose of aprotinin to approximately one-third of the currently recommended dosage and still obtain significantly reduced postoperative blood loss in primary cardiac surgery.
Role of thromboxane A2 in muscle injury following ischaemia
Authors: Homer-Vanniasinkam S , Crinnion J N , Gough M J 
Published: March 2007

Abstract
The effect of a thromboxane A2 receptor antagonist (GR32191) on gastrocnemius muscle blood flow, oedema and viability was assessed in a rodent model of 6-h unilateral hindlimb ischaemia and 4-h reperfusion, and the results compared with those in control and normal groups, and in animals undergoing 6-h ischaemia alone. Control animals demonstrated reduced muscle blood flow throughout reperfusion (at 10 min, P &lt;0·01 versus normal, P not significant versus ischaemia; at 120 min, P &lt;0·5 versus normal and ischaemia; at 240 min, P &lt;0·01 versus normal, P not significant versus ischaemia), and the development of muscle oedema (P &lt;0·01 versus normal and ischaemia) and muscle necrosis (P &lt;0·01 versus normal and ischaemia). In contrast, the thromboxane A2 receptor antagonist enhanced muscle blood flow (at 10 min, P &lt;0·01 versus control; at 120 min, P &lt;0·05 versus control; at 240 min, P &lt;0·01 versus control) and preserved muscle viability (P &lt;0·01 versus control; P not significant versus normal and ischaemia). These results indicate that thromboxane A2 is an important mediator of skeletal muscle reperfusion injury and suggest that administration of a thromboxane A2 receptor antagonist may improve limb salvage rates after surgery for acute ischaemia.