bluuebunny/crossref_metadata_2025_split huggingface dataset:
Small bowel volvulus complicating intestinal ascariasis in children
Authors: Wiersma R , Hadley G P 
Published: March 2007

Abstract
Twenty-nine patients in whom small bowel volvulus complicated intestinal ascariasis are reported. Attention is drawn to the varied clinical and radiological presentation and the relationship of volvulus to the use of vermifuge. The mortality of 17 per cent was contributed to by delay in diagnosis and failure of pre-operative resuscitation. Early diagnosis is dependent upon clinical vigilance and repeated radiological assessment of those patients with simple ascaris obstruction who fail to improve rapidly with conservative treatment. The instillation of intraluminal vermifuge intra-operatively has minimized postoperative worm migration through suture lines and anastomoses.
Wound healing response in surgical patients: Recent food intake is more important than nutritional status
Authors: Windsor J A , Knight G S , Hill G L 
Published: March 2007

Abstract
We have recently found that an impairment of the wound healing response (WHR) occurs in surgical patients with protein-energy malnutrition before there are any measurable changes in body fat and protein stores. The hypothesis of this study was that the patients' recent food intake is more important in determining the WHR than the patients' overall nutritional status. We have measured the recent food intake (by dietary recall), the WHR (by hydroxyproline accumulation in subcutaneous GORE-TEX implants), the pre-operative weight loss (per cent), and body fat and protein stores (by in vivo neutron activation analysis) in 83 patients awating a major elective gastrointestinal resection, and divided them into two groups: adequate recent food intake (n = 59) and inadequate recent food intake (n = 24). There was no significant difference between these two groups for age, sex, diagnosis, surgical procedure, weight loss (per cent), or the amount of body fat and protein stores but there was a significant difference in the WHR (1.81 ± 0.16 s.e.m. versus 1.04 ± 0.22 s.e.m. nmol hydroxyproline/mg GORE-TEX, P&lt;0.005). These results show that pre-operative food intake has a greater influence over the wound healing response than absolute losses of protein and fat from body stores and they suggest that the maintenance of a normal food intake up until the time of surgery is of importance in preventing an impairment of the wound healing response.
Urgent and early cholecystectomy for acute gallbladder disease
Authors: Addison N V , Finan P J 
Published: March 2007

Abstract
A retrospective study of 645 cholecystectomies performed in a surgical unit over a 10-year period is presented, of which 236 were carried out during an acute admission. of these 236 cholecystectomies, 195 were performed for acute cholecystitis and 41 for acute gallstone pancreatitis. In the acute cholecystitis group the proportion of patients over 70 years of age was significantly higher (35 per cent) than the corresponding elective group (10.3 per cent). of those patients presenting with complications (empyema, gangrene, perforation, and biliary peritonitis) 51 per cent were over the age of 70 years. The most valuable investigation in the diagnosis of acute cholecystitis was ultrasound carried out within the first 48 h, with positive results in 83 per cent of those examined. The mortality for elective cholecystectomy was 0.5 per cent rising to 4.7 per cent in the urgent/early cholecystectomy group. The mean age of the 11 patients who died was 76 years, 8 of these patients being over the age of 70 years. The mortality in the subgroup of patients over 70 years was 10 per cent rising to 20 per cent in the over-80 age group. There were no deaths in the acute gallstone pancreatitis group. We conclude that emergency or early cholecystectomy is a safe procedure in patients under 70 years of age. However, patients over 70 years present with more serious complications of acute gallbladder disease which necessitate urgent surgery. We therefore recommend early cholecystectomy in patients over 70 years despite the high attendant mortality.
Pancreatic trauma: Acute and late manifestations
Authors: Leppäniemi A , Haapiainen R , Kiviluoto Tuula , Lempinen M 
Published: March 2007

Abstract
A retrospective analysis of 47 patients with pancreatic trauma is presented. A total of 43 patients presented with acute pancreatic injury, 32 after blunt abdominal trauma. Isolated blunt pancreatic injuries were a considerable diagnostic problem with a mean delay from trauma to operation of 9.4 days. At operation peripancreatic drainage in mild injuries and distal resection in cases of ductal injury were the commonest procedures. The overall mortality was 19 per cent, but only three of the eight deaths were attributable to the pancreatic injury. The overall complication rate was 63 per cent and the pancreatic complication rate was 33 per cent. Four patients presented with chronic pancreatitis resulting from previously untreated blunt abdominal trauma 0.5-21 years earlier. Clinically, they did not differ from the manifestations of chronic pancreatitis of other aetiological origins.
Aggressive treatment of severe diffuse peritonitis: A prospective study
Authors: Schein M , Saadia R , Freinkel Z , Decker G A G 
Published: March 2007

Abstract
In a prospective study of 22 patients with diffuse peritonitis managed by the method of electively staged multiple laparotomies, the abdomen was left open in 9 patients. The patients were selected on the basis of the severity of their intra-abdominal infection: only massive faecal peritonitis, postoperative peritonitis and pancreatic abscesses were included. These amounted to only 9 per cent of all patients with intra-abdominal infection treated over a 2-year period. Up to seven re-operations were required per patient. In view of a high mortality rate of 32 per cent, the superiority of this aggressive management strategy over conventional methods is not fully established.
Effect of splenectomy on Gram-negative bacterial clearance in the presence and absence of sepsis
Authors: Cheslyn-Curtis S , Aldridge M C , Biglin J E J , Dye J , Chadwick S J D , Dudley H A F 
Published: March 2007

Abstract
Severe sepsis leads to depression of the reticulo-endothelial system (RES) with delayed bloodstream clearance of particulate matter and bacteria. Splenectomy results in increased susceptibility to infection with encapsulated organisms but its effect on the resistance to postoperative Gram-negative infection has been little studied. We have investigated the effect of splenectomy on RES function by measurement of plasma fibronectin concentrations and bacterial clearance in the presence and absence of sepsis. In experiment 1, rabbits underwent splenectomy (n=8) or laparotomy only (n=8) 4 weeks before a second laparotomy. In experiment 2, animals had either splenectomy (n=8) or laparotomy only (n=8) followed 4 weeks later by devascularization of the appendix (sepsis). Plasma fibronectin concentrations and the blood clearance and organ distribution of an intravenous injection of 75Se-labelled viable Escherichia coli (2–3 × 108 colony forming units (c.f.u.)) were measured 24 h after the second operation. Splenectomy resulted in: (1) a persistent reduction in plasma fibronectin concentration in the presence and absence of sepsis, and (2) a delay in the bloodstream clearance with reduced hepatic (Kupffer cell) uptake of E. coli which was exaggerated in the septic splenectomized animal. It is concluded that the spleen may be important for Gram-negative bacterial clearance, possibly related to its influence on plasma fibronectin concentration and Kupffer cell function.
Pancreaticogastrostomy: The preferred operation for pain relief in chronic pancreatitis
Authors: Pain J A , Knight M J 
Published: March 2007

Abstract
We present the results of surgery in 53 patients with intractable pain due to chronic pancreatitis associated with pancreatic duct dilatation. Using a limited mucosal to mucosal anastomosis over a silastic T tube the main pancréatic duct was drained in 33 patients into a Roux-en-Y jejunal loop (pancreaticojejunostomy, PJ) and in 20 patients into the stomach (pancreaticogastrostomy, PG). There was one postoperative death in the PJ group and none in the PG group. All patients were followed up for a minimum of four years. There was significantly greater pain relief in the PG group both at 1 (P&lt;0·01) and 4 years (P&lt;0·05) after surgery. We argue that PG is the operation of choice to relieve intractable pain in most patients with chronic pancreatitis associated with duct dilatation.
Contact laser or conventional cholecystectomy: A controlled trial
Authors: Steger A C , Moore K M , Hira N 
Published: March 2007

Abstract
There have been claims that the use of lasers in surgery is associated with reduced operative blood loss, trauma, postoperative pain and improved postoperative mobility. With the development of sapphire probes capable of transmitting neodymium yttrium aluminium garnet (Nd:YAG) laser light, it is now feasible to perform direct-contact low-power laser surgery. In a small randomized controlled trial, we have compared cholecystectomy performed by conventional methods (n = 11) with the same operation performed by contact laser (n = 10). Operative time, blood loss, operative stability, analgesic requirement, mobility and response to the trauma of surgery were compared. The only differences between the two groups were a significantly increased wound infection rate (P = 0·051) in the laser surgery group and a significantly increased length of operating time (P = 0·001). Thus, the laser did not confer any advantage over conventional surgery.
Intra-operative localization of bleeding small intestinal lesions
Authors: Lau W Y , Wong S Y , Ngan H , Fan S T , Wong K K 
Published: March 2007

Abstract
We prospectively studied 12 patients to compare fibreoptic enteroscopy and methylene blue injection through superselectively prepositioned angiographic catheters in intra-operative localization of bleeding small intestinal lesions. Four patients were excluded because the lesions were easily detected by gross examination. Eight patients were subjected to study by these two methods. As methylene blue injection required a positive angiography, it was possible only in five patients. In two of these five patients, non-bleeding lesions were present outside the intestinal segments localized by this method. Enteroscopy was simple, accurate and reliable in seven patients. Complete enteroscopy was impossible in one patient with advanced lymphoma because the intestine and its mesentery were matted together. Fortunately, the bleeding ulcers were still within the reach of the endoscope. Enteroscopy localized bleeding small intestinal lesions more exactly than methylene blue injection so that the length of gut resection could be shorter. We, therefore, conclude that enteroscopy is the better intra-operative localization procedure.
Intraparotid anatomy of the facial nerve and retromandibular vein
Authors: Laing M R , McKerrow W S 
Published: March 2007

Abstract
Fifty-four cadaver dissections of the parotid gland and the extracranial course of the facial nerve were made. In 52 out of 54 specimens dissected (96·3 per cent) the retromandibular vein was present and of significant calibre (&gt; 2 mm). In all specimens the main facial nerve trunk or its major divisions were in direct contact with the retromandibular vein at the level of its entry into the parotid gland. This finding is discussed in the context of new developments in body scanning techniques and put forward as a potential adjuvant in the clinical management of lumps in the parotid region.
Risk to surgeons: A survey of accidental injuries during operations
Authors: Hussain S A , Latif A B A , Choudhary A A A A 
Published: March 2007

Abstract
A survey was conducted with the participation of eight consultant general surgeons, two consultant urologists, four consultant orthopaedic surgeons and four surgical residents to find the incidence of accidental injuries to surgeons and their assistants during operations. Of the total of 2016 operations over a one year period there were 112 reported accidental injuries. These included 107 needle stick injuries, 4 knife cuts and 1 diathermy burn. We found that accidental injuries to surgeons during operations were inevitable.
Influence of proximal colostomy on the healing of a left colon anastomosis: An experimental study in the rat
Authors: Udén P , Blomquist P , Jiborn H , Zederfeldt B 
Published: March 2007

Abstract
The healing of an experimental left colon anastomosis protected by a proximal diverting colostomy was studied in the rat. Collagen synthesis in the anastomotic area was measured by incorporation of [3H]proline. With a defunctioning proximal colostomy, the synthesis and accumulation of collagen in the anastomosis was diminished, and the anastomotic strength development delayed and reduced. The development of anastomotic strength seems to proceed according to the level of strain from intraluminal bulk. As the healing of the anastomosis protected by a diverting colostomy was uncomplicated, these findings should not contra-indicate the use of diverting colostomy.
Consequences of blood loss on growth of artificial metastases
Authors: Sing S K , Marquet R L , de Bruin R W F , Hop W C J , Westbroek D L , Jeekel J 
Published: March 2007

Abstract
Previous studies have shown that lung metastases from a non-immunogenic sarcoma (LS175) in BN (homozygous for RT1n) rats were stimulated by blood transfusions. Enhanced growth was also observed after abdominal surgery combined with allogeneic blood transfusions while syngeneic blood transfusions had no effect. These experimental findings have been confirmed in retrospective clinical studies. The allogeneic blood transfusion effect may be avoided in cancer patients by autologous blood transfusions although this implies blood donation before surgery. The aim of the present study was to investigate the effect of blood loss before surgery on formation (‘take’) of lung colonies, and on the outgrowth of established metastases in the BN rat model. These aspects of tumour behaviour were also investigated in rats undergoing surgery, or receiving blood transfusion, or both, after blood loss. The results indicate that blood loss has a profound stimulating effect on the growth of established metastases, but not on the ‘take’ of tumour cells. This stimulating effect was also present when blood loss was combined with surgery, while previously surgery alone was found to have no effect. Allogeneic and syngeneic transfusions in combination with blood loss both had a strong stimulating effect on growth of established lung metastases. The results indicate that blood loss may be an important factor in determining the outcome of metastatic growth.
Prognosis of colorectal cancer in the elderly
Authors: Irvin T T 
Published: March 2007

Abstract
The prognosis of colorectal cancer in the elderly was examined in a study of 306 consecutive patients. The patients were divided into two groups: Group 1 included 171 patients of average age 77 years (range 70–97); Group 2 comprised 135 patients of average age 59 years (range 22–69). There was no significant difference between the two groups with regard to the mode of presentation, the location and Dukes' classification of the tumours, the incidence of palliative operations, and the perioperative mortality. The surgical mortality rates in Group 1 were 6 per cent overall, 4 per cent after elective operations, and 16 per cent after emergency surgery; the corresponding mortality rates for Group 2 were 3 per cent, 1 per cent, and 20 per cent. Emergency surgery was associated with a significantly higher incidence of perioperative death at any age (P&lt;0.001) and most deaths resulted from complications of coexisting medical disorders or thrombo-embolic complications. Crude actuarial 5-year survival curves showed an increased death rate in Group 1 after 18 months and a significantly lower 5-year survival (P&lt;0.05) but the age-corrected survival curves for the two groups were not significantly different, and it was concluded that the prognosis for colorectal cancer in the elderly is not significantly different from that of younger patients.
Outcome of patients with rectal cancer treated by stapled anterior resection
Authors: Belli L , Beati C A , Frangi M , Aseni P , Rondinara G F 
Published: March 2007

Abstract
The mortality, morbidity and long-term survival in stapled anterior resection for rectal carcinoma has been analysed in 74 patients. Twelve patients were Dukes' A, 26 B, 29 C, and 7 ‘D’ (submitted to hepatic resection). Operative mortality rate was 3 per cent. Three patients (4 per cent) had clinical anastomotic leakage. Two patients (3 per cent) developed anastomotic stenosis. Local recurrence was present in three patients (4 per cent). The mean (± s.e.m.) overall survival rate at 5 years was 67±6 per cent. There was no significant difference in survival between Dukes' B and C (70±10 per cent versus 59±10 per cent, P = 0.209). Patients with absent local spread had a significantly better 5-year survival rate than those with positive local lymph nodes (80±7 per cent versus 54±9 per cent, P&lt;0.01). The present results confirm the satisfactory use of the EEAR stapler device for colorectal anastomoses in rectal cancer and in patients with resectable liver metastasis.
Rigid sigmoidoscopy: An evaluation of three parameters regarding diagnostic accuracy
Authors: Mann C V , Gallagher P , Frecker P B 
Published: March 2007

Abstract
Rigid sigmoidoscopy is the method employed for examining the rectum and sigmoid colon in most general surgical clinics. Commonly, this is performed without any prior preparation of the bowel and with the patient in the left lateral (Sims') position. This study was designed to assess three factors relating to this method: preparation of the bowel; position of the patient; and the experience of the operator. The study shows that diagnostic accuracy without preparation is adequate in only 50 per cent of cases but, by employing a preliminary disposable (Fletcher's) enema, this can be improved to 80 per cent. Employing the knee-elbow position gave only slight advantage over the usual Sims' position and operator experience did not improve diagnostic accuracy once familiarity with the use of the sigmoidoscope had been achieved. The study underlines the importance of preparation as an essential prelude to sigmoidoscopy.
Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by elastic stockings
Authors: Stacey M C , Burnand K G , Layer G T , Pattison Marion 
Published: March 2007

Abstract
Calf muscle pump function was assessed in 41 limbs after venous ulcers had healed. Treatment was then randomized either to ligation of incompetent lower leg communicating veins and ablation of incompetent superficial veins combined with permanent graduated compression elastic stockings, or to graduated compression elastic stockings only. Half volume refilling time (TV1/2) and relative expelled volume (EVrel) measured on foot volume plethysmography were used to assess calf muscle pump function. This was repeated after 12 months. The initial TV1/2 and EVrel were significantly lower than for normal limbs. There was no significant improvement in TV1/2 in either treatment group (Student's t test, P = 0.78, P = 0.19). EVrel did not improve significantly in limbs treated with elastic stockings alone (P = 0.94), but there was a slight but significant improvement in EVrel in limbs treated with surgery and elastic stockings (P = 0.048); however, this was still significantly below the normal range (P&lt;0.001). In limbs without phlebographic evidence of post-thrombotic changes, treated with the combination of surgery and elastic stockings, there was a significant improvement in EVrel (P = 0.035), but no improvement was found in limbs with post-thrombotic changes. This small but significant improvement in EVrel in limbs without post-thrombotic changes treated by surgery and elastic stockings may explain the reduced incidence of reulceration that has been found following surgical eradication of the superficial and communicating veins.
Incidence of deep vein thrombosis after major abdominal surgery in Brisbane
Authors: Reasbeck P G , Guerrini S , Harper J , Sackelariou R , McCaffrey J F 
Published: March 2007

Abstract
There is some evidence that postoperative deep vein thrombosis (DVT) may be commoner in cool than in warm climates. To determine whether this complication is less common in the subtropical climate of Brisbane than in more temperate locations, the incidence of DVT after major abdominal surgery was assessed by 125I fibrinogen scanning. In order to avoid overestimating the incidence of DVT, abnormal scans were accepted as diagnostic only if the DVT was confirmed by venography or if the abnormality on the scan fulfilled more stringent criteria than have previously been applied. Thirty-six of 152 patients (24 per cent) developed a DVT; this incidence was significantly lower than in one previous study from Melbourne and higher than that found in South-East Asia and East Africa, but was not significantly different from that reported from Sydney, Japan and several centres in North America and Britain. There was no apparent seasonal variation in the incidence of the complication. The geographical variation in incidence of postoperative DVT may have been overestimated in previous reports and may be at least partly due to variations in screening technique.
Clinical application of the cholecystokinin provocation test
Authors: Sunderland G T , Carter D C 
Published: March 2007

Abstract
This paper reviews the value of administration of cholecystokinin (CCK) in the assessment of patients thought to have acalculous biliary pain. The literature contains conflicting reports and there is no unequivocal evidence to support the use of CCK provocation tests as a basis for deciding the need for cholecystectomy.
Sphincter of oddi dysfunction: Results of treatment by endoscopic sphincterotomy
Authors: Neoptolemos J P , Bailey I S , Carr-Locke D L 
Published: March 2007

Abstract
From a consecutive series of 451 patients with post-cholecystectomy symptoms referred for endoscopic retrograde cholangiopancreatography (ERCP), 40 (9 per cent) were diagnosed as having sphincter of Oddi dysfunction. Eight patients were excluded from the study because of incomplete data (n=6) or additional diagnoses (n = 2). Thirty of the patients had successful ERCP and endoscopic sphincterotomy (ES); this failed in the remaining two because of severe papillary stenosis (6·3 per cent). Endoscopic biliary manometry was performed in 23 patients (77 per cent). Immediate post-ES complications occurred in eight patients (25 per cent). At a median follow-up of 46 months (range 10-88 months) 19 patients had a good outcome (63·3 per cent) and 11 patients had a poor outcome (36·7 per cent). Patients with a good outcome tended to have a delay of months or years following cholecystectomy before the development of symptoms (median 6 years versus 0 years, P = 0·0003). At ERCP, patients with a good outcome had greater common bile duct diameters (mean ± s.d. mm, 12·6 ± 3·6 versus 8·8±1·8, P = 0·0003) and delayed drainage from the biliary tree of injected contrast (13 versus 2 patients, P = 0·02). Endoscopic biliary manometry was abnormal in all 15 patients with a good outcome in whom it was performed but in only 3 out of 8 patients with a poor outcome (P = 0·003). Sphincter of Oddi dysfunction is an important, albeit uncommon, cause of post-cholecystectomy symptoms. ES provides symptomatic relief in the majority of patients but improved criteria for predicting outcome are required.