bluuebunny/crossref_metadata_2025_split huggingface dataset:
Purse-string suture for stapled oesophagogastric anastomosis: Hand-sewn versus automatic
Authors: O'Riordain D S , Buckley D J , Waldron D J , Kirwan W O 
Published: March 2007

Abstract
An automatic purse-string device was compared with the traditional hand-sewn method in stapled oesophageal anastomosis. Fifteen greyhound dogs underwent distal oesophagectomy with stapled. gastro-oesophageal anastomosis; a purse-string suture was used to draw the distal oesophagus around the stapling device. The animals were randomized into group 1 (n = 8), in which the automatic device was used, and group 2 (n = 7), in which the oesophageal purse string was hand-sewn. The automatic device failed to incorporate the oesophageal mucosa and submucosa reliably into the anastomotic staple line. There were five defective anastomoses in group 1 and none in group 2 (P = 0·037). Anastomotic bursting pressures were significantly reduced in group 1 compared with group 2 (median (range) 47(22-110) versus 82(68-88) mmHg, P = 0.032). Within group 1, a significant difference in bursting pressure existed between complete anastomoses and those in which the mucosa was not fully incorporated (median (range) 75 (60-110) versus 39 (22-50) mmHg, P = 0·037). Median (range) breaking strengths where anastomoses were incomplete were lower than where all layers were incorporated (1420 (1250-2220) versus 1990 (1590-2475) g/cm, P = 0·009). This study questions the safety of the automatic purse-string device for oesophageal anastomosis when used in accordance with present recommendations. Further evaluation and possibly modification of either the instrument design or the methods recommended by the manufacturer for its use are warranted.
Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis
Authors: Cherqui D , Panis Y , Rotman N , Fagniez P-L 
Published: March 2007

Abstract
From 1983 to 1991, 42 patients were operated on for hepatocellular carcinoma (HCC) complicating cirrhosis. Five presented with spontaneous rupture of the tumour: three had posthepatitis B and two non-A non-B cirrhosis. By contrast, 65 per cent of patients with non-ruptured HCC had alcoholic cirrhosis (P &lt; 0.01). Laparotomy was carried out on an emergency basis (four patients) or after a 12-h delay (one) because of haemodynamic instability. Liver resection was performed in four cases (two wedge resections, one segmentectomy III, one extended right hepatectomy) and in the fifth patient hepatic artery ligation was performed. Bleeding was controlled after all four resections with one postoperative death, while the patient treated by ligation died during operation. Of the three surviving patients after liver resection, two died, 6 and 12 months after surgery. One patient is alive with recurrent tumour 43 months after extended right hepatectomy. The present data, combined with analysis of 250 cases of ruptured HCC from the literature, indicate that emergency resection is the treatment of choice in patients with limited tumour and preserved liver function. Transcatheter hepatic artery embolization, if available, is the next choice for high-risk patients or before surgical resection of the tumour. More conservative surgical approaches are the last choice because of poor reported results.
Conventional versus laparoscopic surgery for acute appendicitis
Authors: Tate J J T , Chung S C S , Dawson J , Leong H T , Chan A , Lau W V , Li A K C 
Published: March 2007

Abstract
A total of 155 consecutive patients with suspected acute appendicitis were studied to compare laparoscopic and conventional operations. Patients were not randomized: laparoscopy was performed when a suitably trained surgeon and laparoscopic instruments were available. Laparoscopic appendicectomy was attempted in 51 patients and was successful in 46 (90 per cent); all conversions to open operation were because of marked inflammatory adhesions around the appendix. There were no intraoperative complications. Reintroduction of normal die; and discharge from hospital occurred earlier after laparoscopic than open surgery (P &lt; 0·05). The requirement for analgesia after successful laparoscopic surgery was less than that after conventional appendicectomy, but the difference was not significant. The incidence of wound infection was reduced after the laparoscopic procedure (P = 0·06). It is concluded that laparoscopic appendicectomy is practical and may have advantages over conventional operation, although a randomized study is necessary.
Randomized trial of drainage of colorectal anastomosis
Authors: Sagar P M , Couse N , Kerin M , May J , MacFie J 
Published: March 2007

AbstractA prospective randomized trial was carried out to determine whether use of a high-pressure closed-suction intraperitoneal drain was associated with a reduction in morbidity rate after colorectal resection and to examine the influence of drainage on postoperative fluid collections. A consecutive series of 148 patients who underwent colonic or colorectal resection were randomized to receive no drain (n = 51) or a high-pressure closed-suction drain for either 3 (n = 47) or 7 (n = 47) days. Three patients were excluded. All patients underwent abdominal ultrasonography on days 3 and 7 and those undergoing left-sided colorectal resection (n = 96) received a water-soluble contrast enema on day 7. The three groups of patients were similar in age, sex, diagnosis and the numbers of sutured and stapled anastomoses. The presence of a drain did not influence the postoperative morbidity or mortality rate. If the anastomosis leaked, neither faeces nor pus emerged from the drain. Ultrasonographic detection of a fluid collection was of no value: such collections bore no relationship to radiological or clinical leaks or the postoperative course. Routine use of a high-pressure suction drain after colorectal resection appears to be unnecessary.
Colonoscopic follow-up after resection for colorectal cancer: A selective policy
Authors: Barlow A P , Thompson M H 
Published: March 2007

Abstract
A policy of selective colonoscopy after resection for colorectal cancer was evaluated to assess the benefit of detecting missed synchronous and metachronous tumours in patients under 70 years of age with a good prognosis, and the possible risk of missing such lesions in those not screened. With preoperative barium enema and palpation at laparotomy, synchronous cancers and adenomas were found in 2 and 28 per cent, respectively, of 275 consecutive patients undergoing resection. Eighty-five patients were selected for postoperative colonoscopy, which was repeated at least once in 32, there being a total of 60 repeat examinations. Adenomas, but no cancers, were found in 19 patients (22 per cent) on first screening, but on repeat colonoscopy early metachronous cancers were detected in three patients (9 per cent) and adenomas on 21 examinations (35 per cent). Only one of the patients followed by clinical examination developed a symptomatic tumour. This suggests that postoperative colonoscopy is unlikely to benefit the majority but may be extremely important for young fit patients with continuing polyp formation who are at high risk of developing metachronous cancer.
Pharmacological study of the internal anal sphincter in patients with chronic anal fissure
Authors: Regadas F S P , De O. Batista L K , Albuquerque J L A , Capaz F R 
Published: March 2007

Abstract
A pharmacological study of the internal anal sphincter (IAS) was undertaken in patients with chronic anal fissure. The sensitivity of the IAS to the contractile effect of phenylephrine and potassium chloride and to relaxation by isoproterenol was evaluated. Supersensitivity of the IAS to relaxation by isoproterenol was noted. Further research is necessary to determine the pharmacological basis of such a disturbance.
Infrainguinal vein graft stenosis
Authors: Varty K , Allen K E , Bell P R F , London N J M 
Published: March 2007

Abstract
Although knowledge of the biological processes involved in the development of intimal hyperplasia has increased markedly in recent years, the precise aetiology of infrainguinal vein graft stenosis remains undetermined. Current therapy is therefore directed at treatment of the established lesion rather than its prevention. There seems little doubt, however, that recent advances in understanding of the vascular biology of normal and pathological saphenous vein will eventually lead to specific targeted therapy that will allow the prevention of vein graft stenosis.
Biliary drainage in obstructive jaundice: Experimental and clinical aspects
Authors: Clements W D B , Diamond T , McCrory D C , Rowlands B J 
Published: March 2007

Abstract
Jaundiced patients undergoing invasive diagnostic and therapeutic procedures are at increased risk of complications and death. Despite the large number of clinical and experimental investigations carried out to identify relevant risk factors, no single parameter has been found to be consistently useful in predicting morbidity or mortality. Biliary decompression was initially employed by surgeons and subsequently by interventional radiologists. More recently, endoscopic retrograde cholangiopancreatography has provided an alternative route for decompression of the biliary tree and preliminary data using this method are encouraging. Although there are enthusiastic proponents of various therapeutic techniques, controlled trials have not been convincing in highlighting the benefits of biliary drainage or in determining the best approach. This article reviews the literature pertaining to this complex surgical problem; an attempt has been made to balance the advantages and disadvantages of biliary decompression as palliation and/or preliminary treatment for extrahepatic biliary obstruction.
Foot volumetry and duplex ultrasonography after saphenous and subfascial perforating vein ligation for recurrent venous ulceration
Authors: Bradbury A W , Stonebridge P A , Callam M J , Ruckley C V , Allan P L 
Published: March 2007

Abstract
Forty-three patients undergoing superficial and perforating vein ligation for recurrent venous ulceration underwent preoperative and postoperative foot volumetry and postoperative duplex ultrasonography. Patients were followed for a median of 66 (range 18–144) months. Of nine patients who developed recurrent ulceration, six had femoral vein incompetence and all had popliteal vein incompetence demonstrated by duplex ultrasonography. Of the 34 patients who remained ulcer-free, five had femoral vein incompetence and a single patient had popliteal vein incompetence on duplex scanning, giving positive predictive values for recurrent ulceration of 55 per cent (femoral vein incompetence) and 90 per cent (popliteal vein incompetence). Patients with saphenofemoral incompetence on late follow-up were also more likely to suffer recurrence. Preoperative foot volumetry with tourniquet occlusion of superficial veins showed that the median expulsion fraction of patients who developed recurrent ulcer during follow-up was 0.8 (range 0.6–2.3) per cent compared with 1.5 (range 0.4–2.9) per cent for those who remained ulcer-free (P = 0.025); the median half-refilling time of patients with recurrent ulcer was 1.5 (range 0.5–5.5) s compared with 5.0 (range 0.5–23.0)s for those without recurrence (P &lt; 0.01). Postoperative foot volumetry showed similar differences. Deep venous incompetence, particularly of the popliteal segment, as demonstrated by duplex ultrasonography and foot volumetry, is a useful predictor of recurrent ulceration after subfascial perforator and superficial venous ligation.
Non-therapeutic operations for penetrating trauma: Early morbidity and mortality
Authors: Demetriades D , Vandenbossche P , Ritz M , Goodmann D , Kowalszik J 
Published: March 2007

Abstract
A prospective study was carried out to assess the incidence and type of complications after non-therapeutic operations for penetrating trauma. A total of 372 operations were performed on 368 patients with penetrating injuries to the abdomen (240 procedures), chest (49), neck (48) and extremities (35). There were 46 negative or non-therapeutic operations. The incidence of major complications directly related to anaesthesia or operation in this group of patients was 4 per cent (two patients). The operation might have contributed to a further three major complications. The mean hospital stay for patients undergoing uncomplicated non-therapeutic operation was 4.1 days; for those with complications it was 21.2 days. It is concluded that non-therapeutic operations for penetrating trauma carry a significant morbidity rate. A policy of selective conservatism is advocated.
Use of silicone implants after wide local excision of the breast
Authors: Thomas P R S , Ford H T , Gazet J C 
Published: March 2007

Abstract
The appearance of the breast after wide local excision for carcinoma may be unsatisfactory. In 59 patients undergoing wide local excision a silicone prosthesis was inserted into the cavity at the time of primary surgery. Assessment of the cosmetic result was performed after 12 months by questionnaire and clinical examination. Four prostheses were removed within 1 year because of infection (two patients), wound breakdown (one) and pain (one). Seven prostheses were subsequently removed because of severe capsular contraction. Capsular contraction was more common in patients who had received radiotherapy. Only 23 patients found the results of the implant acceptable or satisfactory. The immediate use of intramammary implants after wide local excision is currently associated with a poor cosmetic result, and the problem of the distorted breast after such excision requires continued attention.
Randomized trial of laser scalpel for modified radical mastectomy
Authors: Wyman A , Rogers K 
Published: March 2007

Abstract
The efficacy of a contact neodymium yttrium-aluminium–garnet laser scalpel was assessed during breast surgery. Forty consecutive women undergoing modified radical mastectomy were randomized to operation performed with a conventional or laser scalpel. The laser scalpel was associated with a significant reduction in mean operative blood loss (149 versus 421 ml; 95 per cent confidence interval of difference 176–368 ml, P &lt;0.001), but the mean operating time was longer (105 versus 80 min; 95 per cent confidence interval of difference 16–34 min, P &lt;0.001). No significant differences were found in the volume of postoperative wound drainage, incidence of axillary seroma, postoperative pain score or time to return of shoulder mobility. Use of a laser scalpel in breast surgery cannot be recommended.
Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastrooesophageal reflux disease
Authors: Janssen I M C , Gouma D J , Klementschitsch P , van der Heyde M N , Obertop H 
Published: March 2007

Abstract
Teres cardiopexy was compared with Nissen fundoplication in a prospective randomized study of surgery for gastro-oesophageal reflux disease refractory to medical treatment. Follow-up at 3 months of ten patients undergoing each procedure showed good clinical results and improvement of the mean symptom score in both groups, for cardiopexy from 7.8 to 1.1 (P &lt;0.01) and for fundoplication from 5.7 to 0.2 to (P &lt;0.01). After 1 year, six of the ten patients undergoing cardiopexy required a second antireflux procedure because of recurrent disease, whereas one reoperation was performed after fundoplication. The mean symptom score after 1 year was higher in patients submitted to cardiopexy than in those receiving fundoplication (3.9 versus 0.3, P &lt;0.01). The mean endoscopic oesophagitis score after 1 year was no different from preoperative values after cardiopexy (1.9 versus 1.9) but was significantly lower after fundoplication (1.5 versus 0.3, P = 0.01). Ambulatory 24-h pH monitoring showed a significantly higher proportion of total time at pH &lt; 4 after cardiopexy then fundoplication (24.0 versus 3.8 per cent, P &lt;0.05). Cardiopexy is significantly less effective than fundoplication for the treatment of gastro-oesophageal reflux disease assessed at 1-year follow-up. This study does not support the use of cardiopexy either in conventional or laparoscopic antireflux surgery.
Prognostic significance of histological type in gastric carcinoma with invasion confined to the stomach wall
Authors: Iriyama K , Miki C , Ilunga K , Osawa T , Tsuchibashi T , Suzuki H 
Published: March 2007

Abstract
Survival was determined after resection for the two main histological types of gastric carcinoma, intestinal (n = 223) and diffuse (n = 170), in 393 patients with pT1 or pT2 tumours. Lymph node metastases were present in 94 patients. The 10-year survival rate was significantly lower for patients with intestinal-type than for those with diffuse-type carcinoma (72 versus 91 per cent, P &lt;0.005). In patients without nodal involvement, the 10-year survival rate was still lower for those with intestinal-type cancer (70 versus 94 per cent, P &lt;0.01). Recurrence of carcinoma was more often by haematogenous dissemination in patients with intestinal-type cancer. Although the results of resection for pT1 or pT2 gastric carcinoma can be acceptable, the introduction of adjuvant therapy based on histological findings may be necessary for patients with the intestinal type of cancer to prevent haematogenous spread of carcinoma to the liver.
Intraoperative enteroscopy in Crohn's disease
Authors: Smedh K , Olaison G , Nyström P-O , Sjödahl R 
Published: March 2007

Abstract
Intraoperative small bowel endoscopy was performed on 33 occasions in 31 patients with Crohn's disease. The extent of mucosal inflammation was compared with that of changes in the external bowel wall: serositis, fat-wrapping and mural thickening. The influence of endoscopic findings on surgical management was evaluated. Mucosal inflammation was generally more extensive than serositis (P &lt; 0.01), but less so than mural thickening (P &lt; 0.001). The extent of fat-wrapping did not differ from that of mucositis. Of 23 patients undergoing reoperation or with fistula or abscess, however, eight had serositis and/or fat-wrapping in bowel segments without mucosal inflammation. Endoscopic findings influenced surgical decisions on 20 of the 33 occasions, limiting planned resection in 14, identifying strictures for repair in one, and deciding against resection in two cases and for extended resection in three. These results suggest that external inflammatory changes are unreliable guides to the extent of intestinal mucositis and requirements for resection in Crohn's disease. By visualizing the mucosa, intraoperative enteroscopy can provide information for more precise surgery, thereby limiting resection.
Extended left hepatectomy: Technical aspects of an evolving procedure
Authors: Blumgart L H , Baer H U , Czerniak A , Zimmermann A , Dennison A R 
Published: March 2007

Abstract
Lessons learned in an operative experience of 14 patients submitted to extended left hepatectomy for the management of liver tumours are presented. There were no deaths within 30 days of operation. Essential preoperative studies, indications and technical details of the operation are described. The importance of the morphology of the tumour and the influence of the tumour on the technique to be adopted are emphasized. Modifications of technique that allow selection of patients for the procedure, control of venous bleeding, accurate identification of the sectoral portal pedicles within the right liver and definition of the plane of parenchymal transection are addressed.
Safety of double-stapled anastomosis in low anterior resection
Authors: Redmond H P , Austin O M B , Clery A P , Deasy J M 
Published: March 2007

Abstract
Clinical leakage of the anastomosis follows low anterior resection for rectal carcinoma in 5–10 per cent of patients despite standard stapling techniques. A modification of this method has obviated the need for a distal purse string. A flexible transverse stapling instrument (Roticulator 55) is applied across the rectum below the tumour, and a double staggered row of staples is inserted as a substitute for the distal purse string. End-to-end stapled anastomosis is then performed with peranal insertion of a Premium CEEA stapling instrument. In 111 patients the indications for operation were colorectal carcinoma (96 patients), diverticulosis (ten), megarectum (four) and ulcerative proctocolitis (one). Three patients had clinical evidence of anastomotic leakage; all survived. The incidence of radiological leakage on Gastrografin enema 10–12 days after operation was 9 per cent. The perioperative mortality rate was 2 per cent; all deaths were from cardiovascular causes. Local recurrence of tumour occurred in eight patients (7 per cent) after a mean follow-up of 40 months. In conclusion, double-stapled end-to-end anastomosis has made low anterior resection for rectal carcinoma a safe procedure with a low mortality rate, an acceptable local recurrence rate and minimal (clinical) anastomotic leakage.
Reappraisal of radical local excision for carcinoma of the rectum
Authors: Lock M R , Ritchie J K , Hawley P R 
Published: March 2007

Abstract
Outcome in all 167 patients treated by radical local excision for rectal carcinoma between 1948 and 1984 at St Mark's Hospital was assessed in terms of the original tumour differentiation except for 15 patients with incomplete follow-up or ungraded tumours. Fifty-six of the 152 patients had low-grade tumours, with one death from carcinoma in this group. Of 81 patients with average-grade tumours, ten died from carcinoma of the rectum: two after early reoperation and eight following recurrence. Six of 15 patients with high-grade tumours underwent early reoperation and three of these died from carcinoma. Among the nine patients who did not undergo early reoperation there were three related deaths (two from carcinoma, one after rectal excision for recurrence). Local excision remains a valid therapy for suitable patients with low-grade tumours but is not recommended for those with average-grade lesions. The necessity for early reoperation in patients with high-grade tumours is questioned.
Multicentre study of a continent colostomy plug
Authors: Codina Cazador A , Piñol M , Marti Rague J , Montane J , Nogueras F M , Suñol J 
Published: March 2007

AbstractA multicentre clinical study was carried out to assess the performance of a new disposable device, the Conseal 1-Piece, for colostomy control and continence. Forty-three patients were studied; none had any complication at the stoma. The time elapsed since surgery and the condition of the stoma and surrounding skin were recorded. The new product was compared with the patients usual colostomy bag, studying the following parameters: ease of application, reliability, leakage, confidence, ease of removal, adhesion and comfort. Thirty-seven patients completed the study. No complications arose, and complete faecal continence was obtained with 71.1 per cent of applications. The plug was kept in position for a mean of 11.5 h and a normal stoma bag was used for the remainder of the day. Of the 37 patients who completed the trial, 26 preferred the Conseal 1-Piece to a colostomy bag. In this preliminary study the device was easy to apply, involved no major complications and provided a high degree of continence. This product deserves further study because of its simplicity of use. However, research to improve the level of continence should continue.