bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis
Authors: Eriksson S , Granström L 
Published: March 2007

Abstract
In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment hi patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure
Authors: Maddern G J , Nejjari Y , Dennison A , Siriser F , Bardoxaglou E , Launois B 
Published: March 2007

Abstract
Hartmann's procedure remains the favoured option in patients with acute left colonic and sigmoid disease, despite the well documented morbidity and mortality associated with reversal. In 40 patients with left colonic pathology, primary anastomosis was performed; 32 had a covering transverse colostomy. There were six hospital deaths, five in the transverse colostomy group. Closure was not attempted in seven of the 27 patients surviving with a colostomy (three refused, four had disseminated malignancy). In the 20 undergoing closure, there was no morbidity or mortality. With advances in intensive care, antibiotic therapy and anaesthesia, it is reasonable to consider alternatives to Hartmann's procedure, particularly when subsequent reconstruction is envisaged.
Prospective randomized study of radical versus four piles haemorrhoidectomy for symptomatic large circumferential prolapsed piles
Authors: Seow-Choen F , Low H C 
Published: March 2007

Abstract
Twenty-eight patients (14 men, 14 women) with circumferential prolapsed piles were prospectively randomized to undergo either modified radical haemorrhoidectomy (group 1; 14 patients) or four piles haemorrhoidectomy (group 2; 14). The median duration of surgery was 30 and 10min respectively in groups 1 and 2. After operation all patients in group 1 were continent compared with 12 of 14 in group 2. Two patients in group 2 developed an anal stricture requiring manual dilatation. Five patients in group 1 had wound dehiscence requiring secondary suture; three of these developed an anal stricture: two needed anal dilatation and one required anoplasty. Two patients in group 1 had residual anal skin tags, compared with nine in group 2. Two patients in group 2 had symptomatic residual piles, whereas none in group 1 had this problem. At 6 months, six patients in group 2 considered the results to be excellent, seven acceptable and one was disappointed. In group 1 two considered the operation to be excellent, ten acceptable and two were disappointed.
Survival of patients with surgical wound infection: A case-control study of common surgical interventions
Authors: Poulsen K B , Wachmann C H , Bremmelgaard A , Sørensen A I , Raahave D , Petersen J V 
Published: March 2007

Abstract
A cohort of 4515 surgical patients was selected from ten different surgical intervention groups, and 291 of 317 with a postoperative wound infection were matched 1:1 with controls with regard to intervention, sex and age. The mortality rate was investigated from the time of operation, with a follow-up period from 4 years 4 months to 8 years 4 months. Eighty-seven patients with a deep infection had a significantly increased mortality rate, with a risk ratio of 1·7. Without a distinction between superficial and deep infection the former might mask the higher mortality rate associated with the latter.
Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: A prospective randomized trial
Authors: Tekant Y , Goh P , Alexander D J , Isaac J R , Kum C K , Ngoi S S 
Published: March 2007

Abstract
A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0·01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.
Return to work after laparoscopic cholecystectomy
Authors: McLauchlan G J , MacIntyre I M C 
Published: March 2007

Abstract
To assess whether the introduction of laparoscopic cholecystectomy has led to a change in attitude regarding the resumption of normal activities after operation, the views of 407 general practitioners (GPs) and 532 patients were analysed. Although 99 per cent of GPs thought that laparoscopic cholecystectomy represented an improvement on the open operation, 55 per cent advised significant restrictions in the postoperative period. For the 231 patients in employment who had an uncomplicated laparascopic procedure the mean time of return to work was 3·3 weeks. Although 47 per cent of patients returned to work within 2 weeks, 19 per cent took more than 4 weeks. The self-employed returned significantly earlier than employees. Education through better communication among hospital, general practitioners and patients is required if prevailing attitudes towards the length of convalescence after laparoscopic cholecystectomy are to change.
Liver transplantation in patients with situs inversus
Authors: Watson C J E , Rasmussen A , Jamieson N V , Friend P J , Johnston P S , Barnes N D , Calne R Y 
Published: March 2007

Abstract
Seven patients with situs inversus abdominis and one with situs inversus totalis underwent liver transplantation; all are alive at follow-up of between 7 months and 5 years. Two patients required retransplantation within the first 3 weeks (for primary non-function and thrombotic infarction). Seven had additional abnormalities associated with the polysplenia-biliary atresia syndrome. Liver transplantation in these patients involved selection of relatively small donor organs or use of reduced-size grafts. Delayed abdominal wall closure was necessary in two patients and all required a modification of the ‘piggy-back’ technique of suprahepatic vena caval anastomosis to overcome recipient venous anomalies. Biliary drainage by Roux-en-Y choledochojejunostomy was the preferred technique. Although technically challenging, situs inversus is not a contraindication to liver transplantation and patients should expect full recovery.
Experience of orthotopic liver transplantation and hepatic resection for hepatocellular carcinoma of less than 8 cm in patients with cirrhosis
Authors: Tan K C , Rela M , Ryder S D , Rizzi P M , Karani J , Portmann B , Heaton N D , Howard E R , Williams R 
Published: March 2007

Abstract
Fifteen patients with cirrhosis underwent orthotopic liver transplantation for small hepatocellular carcinoma (HCC) and 12 patients with cirrhosis underwent hepatic resection for similar HCC. All tumours were of the non-fibrolamellar variant. The majority of the patients in the transplant group had Child's grade B or C cirrhosis. Median follow-up was 37 months with a minimum of 18 months. Eleven of 12 patients in the resection group had Child's grade A cirrhosis. Median follow-up was 29 months with a minimum of 16 months. Actuarial survival rates at 1 and 3 years for the transplanted patients were 80 and 63 per cent and all were tumour free. Tumour recurrence rate was 15 per cent. The overall 1- and 3-year tumour-free survival rates for patients in the resection group were 61 and 33 percent. Tumour recurrence rate was 45 percent. The results show orthotopic liver transplantation to be an important surgical option in cirrhotic patients with small HCC, particularly in those with moderate to severe hepatic decompensation.
Long-term results after laparoscopic cholecystectomy
Authors: Ure B M , Troidl H , Spangenberger W , Lefering R , Dietrich A , Eypasch E P , Neugebauer E 
Published: March 2007

Abstract
As part of a continuing audit of patients undergoing laparoscopic cholecystectomy (which now numbers over 1500) 468 of the 508 patients (92·1 per cent) operated on between October 1989 and March 1991 were studied between 350 and 988 days after the operation (mean 19 months). A questionnaire was filled in by each patient before operation and at the late follow-up visit. Eight specific symptoms were sought - non-colicky pain, colic, abdominal distension, nausea, vomiting, loss of appetite, flatulence, and dietary restriction. The result of each operation was assessed by two surgeons and by the patient. In 453 patients (96·8 per cent) the symptoms had improved as a result of the operation, but 260 patients (55·6 per cent) had some abdominal symptoms. The result was assessed as excellent in 310 patients (66·2 per cent); 143 (30·5 per cent) still had abdominal complaints but they were willing to cope with those symptoms. In 15 patients (3·2 per cent) the result was unsatisfactory. Statistical analysis of 26 preoperative variables showed few significant differences between patients with excellent results and patients with persisting or new symptoms. The percentage of patients with biliary colic was reduced from 82·9 per cent before to 6·4 per cent after laparoscopic cholecystectomy (P &lt;0·05), and of those with flatulence from 62·6 per cent to 45·3 per cent (P &lt;0·05). Flatulence persisted in 147 (50·2 per cent) of the 293 patients who had complained of flatulence before the operation, and of the 175 patients who had not complained of flatulence before surgery, 65 (37·1 per cent) reported the symptom for the first time after the operation. It appears that ‘flatulent dyspepsia’ after cholecystectomy has many causes, one of which may be removal of the gallbladder. It is concluded that the long-term results of laparoscopic cholecystectomy in patients with symptomatic gallstone disease were excellent but the prognosis in individual patients was unpredictable.
Serum tumour necrosis factor compared with C-reactive protein in the early assessment of severity of acute pancreatitis
Authors: Paajanens H , Laato M , Jaakkola M , Pulkki K , Niinikoski J , Nordback I 
Published: March 2007

Abstract
Tumour necrosis factor (TNF) is an early mediator of sepsis and multiple organ failure; increased concentrations in serum are also observed in acute pancreatitis. In the present study the predictive value of TNF and C-reactive protein (CRP) concentrations on admission were compared in order to differentiate complicated cases of acute pancreatitis from the mild course in 77 patients. Serum TNF concentration exceeded the detectable level only in seven of 77 patients (9 per cent), although complicated pancreatitis developed in 18 (23 per cent). The sensitivity and overall accuracy of TNF concentration in predicting severe disease were only 16 and 74 per cent respectively. The corresponding values for CRP (concentrations greater than 100 mg/1) were 84 and 74 per cent respectively. These data suggest that, in contrast with CRP, the early determination of peripheral blood TNF concentration is of no clinical value in assessing the severity of acute pancreatitis.
Re-excision of soft tissue sarcoma after inadequate initial operation
Authors: Zornig C , Peiper M , Schroder S 
Published: March 2007

Abstract
Between January 1988 and October 1993, 189 patients with soft tissue sarcoma of the extremities and trunk underwent surgery and since 1988, patients in whom the initial operation did not achieve safe margins underwent reoperation (67 of the 189). At re-excision an en bloc resection of the area with wide margins was achieved in 59 patients. Residual tumour was found in 30 specimens (45 per cent). Thirty-six patients received postoperative radiotherapy and/or chemotherapy. After a mean follow-up of 32 (range 1–69) months five patients (7 per cent) had local recurrence. In view of the high rate of local recurrence after local excision of soft tissue sarcoma (70–90 per cent), primary re-excision is indicated after an inadequate initial operation.
Risk factors in patients presenting as an emergency with colorectal cancer
Authors: Scott N A , Jeacock J , Kingston R D 
Published: March 2007

Abstract
Of 905 patients with colorectal cancer admitted to a single district general hospital, 272 (30 per cent) were admitted as emergencies. Emergency patients had more advanced tumours (Dukes stage B and C 96 per cent versus 88 per cent of those admitted electively, P &lt; 0·006), a shorter history (median 3 versus 11 weeks, P &lt; 0·001), were less likely to be fully ambulatory (44 versus 80 per cent, P &lt; 0·0001) and more likely to have abdominal pain (74 versus 51 per cent, P &lt; 0·001) and vomiting (40 versus 10 per cent, P &lt;0·0001). More emergency patients were given stomas (56 versus 35 per cent, P &lt; 0·0001) and died in hospital (19 versus 8 per cent, P &lt; 0·0001). Of those who survived to be discharged, patients admitted as an emergency spent longer in hospital (median stay 16 versus 13 days, P &lt;0·0001) and had a poorer overall 5-year survival rate (29 versus 39 per cent, P = 0·0001). Emergency patients were significantly older (median 74 versus 72 years, P = 0·04) and much more likely to be widowed (41 versus 27 per cent, P = 0·0002) than those admitted for elective surgery. If the personal and resource disaster of emergency colorectal cancer admission is to be reduced, screening strategies targeted by demographic characteristics require investigation.
Laparoscopic technique for small bowel biopsy
Authors: Greig J D , Miles W F A , Nixon S J 
Published: March 2007

Abstract
The mid-small bowel is relatively inaccessible to the endoscopist. Barium follow-through examination may present a differential diagnosis which includes Crohn's disease and lymphoma. In the past, laparotomy and small bowel biopsy were the only methods to obtain a definitive diagnosis. A laparoscopic technique for taking a full-thickness small bowel biopsy specimen is described.
Comparison of conventional Lewis-Tanner two-stage oesophagectomy with the synchronous two-team approach
Authors: Hayes N , Shaw I H , Raimes S A , Griffin S M 
Published: March 2007

Abstract
Twenty-seven patients with oesophageal carcinoma had subtotal oesophagectomy by the Lewis-Tanner operation (group 1, n=14) or a synchronous modification (group 2, n=13). Synchronous operations were completed more quickly (230 versus 305 min, P &lt; 0·01), but with more time spent under single-lung anaesthesia (160 versus 120 min, P &lt; 0·01) and a greater fall in systolic blood pressure during hiatal manipulation (60 versus 30mmHg, P &lt; 0·01). Operative blood loss was not significantly greater in group 2, but the total volume of blood transfused in the perioperative period was greater in this group (5 versus 3 units, P &lt; 0·01). Four patients in group 1 suffered significant postoperative complications, compared with seven in group 2; three postoperative deaths occurred in group 2. This study suggests that the synchronous two-team oesophagectomy produces a higher incidence of complications than the conventional operation. Continued use of the Lewis-Tanner two-stage oesophagectomy is recommended for patients with carcinoma of the oesophagus.
Total anorectal reconstruction
Authors: Abercrombie J E , Williams N S 
Published: March 2007

Abstract
Abdominal stomas carry a considerable physical and psychological morbidity. Several authors have attempted total anorectal reconstruction (TAR) to avoid a permanent stoma for patients undergoing abdominoperineal excision of the rectum (APER). The published series of TAR are reviewed. There is no evidence that TAR adversely affects survival in patients with cancer. Patients who have undergone reconstruction have variable anorectal function, most suffering from anorectal incontinence to some degree. It appears, however, that the psychological benefit of avoidance of an abdominal stoma outweighs the inconvenience of incontinence for almost all. Refinements in surgical technique, allied with novel methods of achieving neorectal emptying, make TAR a viable alternative to APER in selected patients.
The ileoanal pouch: A risk-benefit analysis
Authors: Köhler L , Troidl H 
Published: March 2007

Abstract
This review assesses whether the risk of ileoanal pouch construction in patients with ulcerative colitis, compared with that of ‘less dangerous’ operations, is compensated by a better postoperative outcome. Even though the mortality rate is not greater for pouch construction, the risk of pelvic sepsis and pouchitis increase morbidity. Bowel function after construction of the ileal pouch, although better than that before operation, is not as good as that of normal controls and does not, in itself, justify increased morbidity. Quality of life measurements suggest that the benefit of the ileal pouch procedure is not much greater than that of ileostomy, even though some dimensions of quality of life are improved. However, most patients wish to avoid an ileostomy and surgeons should respect this wish, remembering that the pouch procedure has some risks and that the gain for the patient may be small.
Definition of local recurrence after surgery for rectal carcinoma
Authors: Marsh P J , James R D , Schofield P F 
Published: March 2007

Abstract
Local recurrence rates of rectal carcinoma have been analysed among 284 patients in a prospective randomized multicentre trial of adjuvant preoperative radiotherapy for locally advanced rectal carcinoma. Wide variations in local recurrence rates are demonstrated depending on the definition of local recurrence employed and the subgroup studied. Thus after surgical operation alone, rates as high as 43.3 per cent or as low as 12.7 per cent can be calculated. After both adjuvant preoperative radiotherapy and operation the overall local recurrence rate is 12.8 per cent, although the local recurrence rate inside the radiotherapy field (true recurrence) may be as low as 2.3 per cent. It is recommended that local recurrence after operation for rectal carcinoma be defined as any detectable local disease at follow-up, occurring either alone or in conjunction with generalized recurrence, in patients who have undergone resection. A rate should be given both for all patients and for those operated on for cure, but not for the latter group alone as this could introduce bias.
Influence of a vein cuff on polytetrafluoroethylene grafts for primary femoropopliteal bypass
Authors: Raptis S , Miller J H 
Published: March 2007

Abstract
A retrospective investigation was performed to study the benefit obtained from a vein cuff inserted at the distal anastomosis of a primary femoropopliteal bypass graft with polytetrafluoroethylene (PTFE). When PTFE was preferred to vein an attempt was made to assess whether there was subsequent use for the spared vein. A series of 559 primary PTFE bypasses was studied and found to have a cumulative patency rate of 62 per cent at 36 months. Subgroups were also studied for a similar period. In the above-knee position there was no difference in the primary patency rate of PTFE with or without a cuff at 36 months (69 versus 68 per cent, P = 0.89). Below the knee, grafts with a cuff had a better 36-month patency rate than those without (57 versus 29 per cent, P = 0.01). Cuffed PTFE for claudication had a better patency rate than that for threatened limbs at 36 months (68 versus 60 per cent, P = 0.03). Thrombectomy of occluded cuffed PTFE grafts improved the 36-month patency rate from 64 to 74 per cent. The limb salvage rate at 36 months was 97 per cent for claudication and 89 per cent for threatened limbs with cuffed PTFE. Occlusion of cuffed PTFE was associated with preservation of outflow in 91 (51 per cent) of 179 cases, permitting subsequent graft thrombectomy or insertion of a new bypass. Spared vein was rarely used to salvage an occluded PTFE graft, and was associated with poor patency and a high amputation rate. Although this study does not support the use of PTFE for the primary graft, PTFE with a vein cuff interposed at the distal anastomosis is a reasonable substitute when vein is not available.
Outcome of patients with abdominal sepsis treated in an intensive care unit
Authors: McLauchlan G J , Anderson I D , Grant I S , Fearon K C H 
Published: March 2007

Abstract
A group of 125 patients with abdominal sepsis admitted to the intensive therapy unit between January 1990 and June 1993 were reviewed to determine outcome. Mean(s.d.) age was 66(12) years and admission Acute Physiology And Chronic Health Evaluation (APACHE) II score 23(9). The hospital mortality rate was 63 per cent. Factors associated with mortality included age, APACHE II score, occurrence of septic shock, chronic ill health, female sex, sepsis of upper gastrointestinal origin and failure to clear the source of sepsis (all P &lt; 0.05). Delay to surgery, anastomotic leakage and presence of malignancy did not influence survival significantly. Quality of life (measured by the World Health Organization performance score) at 15 months after discharge showed 24 of 32 survivors to be independent, ambulatory and capable of self care. No patient survived to become completely disabled. The factors associated with survival did not predict subsequent quality of life. Accurately defining the characteristics of this heterogeneous group of patients is a prerequisite for improved treatment, patient selection and research.
Recurrent inguinal hernia after laparoscopic repair: Possible cause and prevention
Authors: Deans G T , Wilson M S , Royston C M S , Brough W A 
Published: March 2007

Abstract
Eleven patients with recurrent inguinal hernia after laparoscopic hernia repair were referred for treatment. A medial recurrence associated with a mature peritoneal sac was identified in each case. The prosthetic mesh medial to the inferior epigastric artery had rolled away from the pubic ramus to expose Hesselbach's triangle. All cases were successfully treated by insertion of a second mesh to cover the defect and overlap the original mesh. To date there have been no further recurrences. Lessons learnt from experience of such laparoscopic transperitoneal hernia repair include that: the prosthetic mesh must be placed so that it reaches or crosses the midline; at least three staples should fix the mesh to the pubic ramus; a large mesh (13 ± 9 cm) with a greater surface area should reduce the pressure tending to disrupt the mesh; and bilateral hernia is best managed by inserting a single piece of mesh (28 ± 9 cm) fully unfolded as it crosses the midline to ensure coverage of both medial direct defects (‘bikini repair’). Application of these principles may reduce the incidence of recurrence after laparoscopic inguinal hernia repair.