bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic versus open appendicectomy: A prospective assessment
Authors: Lujan Mompean J A , Robles Campos R , Parrilla Paricio P , Soria Aledo V , Garcia Ayllon J 
Published: March 2007

Abstract
A prospective study of 200 consecutive patients with suspected acute appendicitis was performed to compare open and laparoscopic appendicectomy. Formal randomization was precluded by instrument availability. Some 100 patients underwent laparoscopic appendicectomy (conversion to laparotomy was carried out in five) and 100 had conventional surgery. The groups were similar in sex ratio, age, degree of appendiceal inflammation and antibiotic treatment. The mean duration of open appendicectomy was 46 min and of the laparoscopic procedure 51 min (P not significant). Postoperative complications in patients who underwent laparoscopic appendicectomy included: intraabdominal abscess (two patients), wound infection (one), early bowel obstruction (four all resolved with medical treatment) and umbilical haematoma (two). There were no reoperations in the immediate or late postoperative period. Complications after open operation were: wound infection (seven patients) (P &lt; 0·05), early bowel obstruction (five; three resolved with medical treatment, two required surgery) and haematoma of the Surgical wound (one). The mean hospital stay was 4·8 days for laparoscopic appendicectomy and 6·0 days for the open operation (P &lt; 0·05). There were no deaths.
Laparoscopic prosthesis fixation rectopexy for complete rectal prolapse
Authors: Cuschieri A , Shimi S M , Velpen G Vander , Banting S , Wood R A B 
Published: March 2007

Abstract
Five women aged 64–81 years with complete rectal prolapse and incontinence were treated by laparoscopic mobilization of the rectum and posterior fixation to the presacral fascia using Marlex mesh. Mobilization was carried out with standard straight laparoscopic instruments in the first two patients (operating times 3·5 and 4·5 h) and with coaxial curved instruments and ultrasonic dissection in the succeeding three (operating times 2·5, 2·0 and 2·5 h). Restoration to full continence (grade 1) was observed in two patients and to grade 2 in a further two. No recurrence of the prolapse occurred during follow-up of 4–27 months.
Long-term results of postanal repair for neurogenic faecal incontinence
Authors: Setti Carraro P , Kamm M A , Nicholls R J 
Published: March 2007

Abstract
Between 1984 and 1986, 54 patients underwent postanal repair for neurogenic faecal incontinence. Forty-two (41 women) were available for follow-up 5–8 (median 6·2) years after operation. Of these, 34 women attended for clinical and anorectal physiological assessment. Anal endosonography was also performed in 30 patients. In the 34 patients examined, continence categories (Browning and Parks' classification) of C (n = 12) and D (n = 22) before surgery became A (n = 2), B (n = 12), C (n = 16) and D (n = 1) at 6 months and A (n = 4), B (n = 5), C (n = 21) and D (n = 4) at 5–8 years. Nine patients therefore had continence for solids and liquids, five of whom were incontinent to flatus, in the long term. Assessment of outcome by patients revealed long-term improvement in 28 and no change in six. Two of the 34 patients assessed were housebound because of incontinence. Of the total of 54 patients, only one required a stoma. The length of the anal canal increased significantly from a preoperative median (range) of 2·0 (1·5–4·0) cm to 3·8 (1·8–5·5) cm 5–8 years after surgery. Perineal descent at rest decreased markedly. Progression of neuromuscular damage was demonstrated by prolongation of the pudendal nerve terminal motor latency from a median (range) 2·38 (1·80–3·35) ms to 2·80 (2·20–4·25) ms and increasing median (range) fibre density in the external sphincter, from 1·86 (1·76–2·40) to 3·63 (2·03–6·20). The pudendal nerve terminal latency was the only preoperative physiological variable that correlated significantly with long-term outcome (A and B 2·20 ms versus C and D 2·65 ms, P &lt; 0·05). At long-term assessment, maximal anal squeeze pressure was the only physiological variable that correlated significantly with clinical outcome. Anal endosonography revealed a clinically undetected sphincter defect in 19 of 30 patients examined but the presence of a defect did not relate to clinical outcome.
Femoropopliteal angioplasty for severe limb ischaemia
Authors: Currie I C , Wakeley C J , Cole S E A , Wyatt M G , Scott D J A , Baird R N , Horrocks M 
Published: March 2007

Abstract
Fifty patients undergoing 51 percutaneous transluminal angioplasties of the femoropopliteal segment for severe limb ischaemia were reviewed regularly. They comprised 30 men and 20 women of median age 70 (range 56–85) years. There were two deaths within 30 days. At 2 years the cumulative patient survival rate was 60 per cent. Eleven angioplasties were technical failures, 25 failed in the first 6 months and 14 were successful at 6 months' follow-up; in addition one patient died from myocardial infarction within 30 days of technically successful angioplasty. Subsequent vascular procedures were successful in 11 limbs following failed angioplasty. The primary limb survival rate was 42 per cent at 2 years. There were eight major complications after angioplasty, requiring amputation in five instances. Of the 23 long occlusions (greater than 5 cm) that were recanalized and dilated, 22 procedures failed within 6 months. The run-off score and diabetic status did not predict outcome. In this group of patients angioplasty had a low durability. Dilatation of long occlusions is associated with high rates of reocclusion and, on the basis of these results, should not be performed.
Ultrasonography as a method of measuring breast tumour size and monitoring response to primary systemic treatment
Authors: Forouhi P , Walsh J S , Anderson T J , Chetty U 
Published: March 2007

Abstract
Accurate measurement of change in tumour size is a prerequisite for the use of response-based regimens of primary systemic therapy for breast cancer. This study evaluated the accuracy of clinical assessment, mammography and ultrasonography in measuring tumour size and in monitoring response to treatment. Size was determined during the week preceding surgery and actual size measured from resected specimens. Sequential measurements were performed in 35 patients undergoing primary systemic treatment. There was moderate correlation between pathological and clinical size (n = 51, r2 = 0·68, P&lt;0·0001). Close correlation with pathological tumour size was observed for mammographic (n = 45, r2 = 0·84, P&lt;0·0001) and ultrasonographic (n = 52, r2 = 0·89, P&lt;0·0001) tumour size. Response was correctly evaluated by clinical assessment in 31 of 35 patients, by mammography in 20 of 35 and by ultrasonography in 31 of 35. Actual tumour size can be measured accurately by available imaging techniques but ultrasonography is the most practical and accurate method for monitoring response.
Resection of ‘recurrent’ colorectal metastases to the liver
Authors: Que F G , Nagorney D M 
Published: March 2007

Abstract
Hepatic resection is the only treatment for patients with colorectal cancer metastatic to the liver that has resulted in long-term survival. This apparent efficacy of hepatectomy has prompted efforts to expand the surgical approach for disease progression within the liver. A review of personal experience and of the literature was performed in an attempt to define the role of surgery for disease progression. Twenty-one patients who underwent hepatic resection between 1983 and 1991 for isolated disease progression in the liver were retrospectively reviewed. The median follow-up of patients still alive was 1·7 years (range 4 months to 4·5 years). The median survival from the date of repeat hepatic resection was 3·4 years with an estimated actuarial survival rate of 43 per cent at 4 years. These patients experienced no significant morbidity and the mortality rate was 5 per cent. Hepatic resection of metastatic colorectal carcinoma can produce long-term survival without prohibitive risk. These findings support an aggressive surgical approach for metastatic progression in the liver from colorectal carcinoma.
Anorectal myotomy combined with anterior resection in the treatment of Hirschsprung's disease
Authors: Scobie W G 
Published: March 2007

Abstract
A total of 42 patients with biopsy-proven Hirschsprung's disease were treated by anorectal myotomy or myectomy, alone or combined with anterior resection. Myotomy is a simple and complication-free procedure. The results compare favourably with those of other operative procedures for this condition.
Comparison of emergency and elective haemorrhoidectomy
Authors: Eu K-W , Seow-Choen F , Goh H S 
Published: March 2007

Abstract
A total of 704 patients with symptomatic prolapsed haemorrhoids were operated on over a 24-month period. Overall, 500 underwent elective haemorrhoidectomy for symptomatic prolapsed haemorrhoids and 204 emergency haemorrhoidectomy for acutely prolapsed, thrombosed or gangrenous haemorrhoids. The mean age was 43 (range 16–80) years in patients undergoing elective surgery and 42 (range 20–86) years in those receiving emergency procedures. After elective surgery 27 patients (5·4 per cent) had an episode of secondary haemorrhage; ten (2·0 per cent) required blood transfusion and six (1·2 per cent) needed surgical haemostasis. After emergency surgery, ten patients (4·9 per cent) developed secondary haemorrhage; four (2·0 per cent) required blood transfusion and two (1·0 per cent) surgical haemostasis. Twelve patients (5·9 per cent) developed anal stenosis after an emergency procedure compared with 15 (3·0 per cent) after elective operation. None of the patients in either group developed portal pyaemia. After elective surgery 26 patients (5·2 per cent) developed a degree of incontinence (eight to flatus, 15 to liquids, three to solids) as did nine patients (4·4 per cent) after emergency procedures (three to flatus, five to liquids, one to solids). Recurrent haemorrhoids were found in 38 patients (7·6 per cent) after elective surgery and in 14 (6·9 per cent) after an emergency procedure.
Circulating intact parathyroid hormone levels in acute pancreatitis
Authors: McKay C , Beastall G H , Imrie C W , Baxter J N 
Published: March 2007

Abstract
Serum levels of parathyroid hormone (PTH), calcium and albumin were measured daily for 5 days in 41 selected patients with moderate to severe acute pancreatitis. The PTH level was measured by means of a two-site immunoradiometric assay specific for the intact polypeptide. A rise in PTH level was observed more commonly in patients with a complicated or fatal outcome than in those with an uncomplicated course (14 of 16 versus six of 25 patients, P &lt; 0.001). Although PTH levels were variable in the presence of hypocalcaemia, raised concentrations were found more frequently in patients with complications (seven of eight versus two of seven without complications, P = 0.035). This study confirms that an appropriate rise in PTH level occurs in response to the hypocalcaemic stimulus in patients with acute pancreatitis.
Recurrent varicose veins: Assessment of the saphenofemoral junction
Authors: Bradbury A W , Stonebridge P A , Callam M J , Walker A J , Allan P L , Beggs I , Ruckley C V 
Published: March 2007

Abstract
Thirty-six consecutive unselected patients, who had apparently previously undergone saphenofemoral ligation for primary uncomplicated long saphenous varicosities and who had then re-presented with recurrent thigh varices emanating from the groin, underwent preoperative clinical assessment, hand-held Doppler and duplex ultrasonographic examination and varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent re-exploration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or perineal veins (type II recurrence). Clinical examination alone was poor at distinguishing type I from type II recurrence. Doppler ultrasonography was sensitive (88 per cent) but non-specific (40 per cent). In contrast, duplex scanning was insensitive (42 per cent) but extremely specific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive predictive value of 100 per cent, a sensitivity of 73 per cent and in addition provided a precise anatomical ‘road-map’. A combination of clinical examination and hand-held Doppler ultrasonography seems to be the most appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additional useful information about both the SFJ and the presence of thigh perforators. Contrast examination may be reserved for patients who have equivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous disease.
Accuracy of ultrasonographic measurement of infrarenal abdominal aortic aneurysm
Authors: Akkersdijk G J M , Puylaert J B C M , Coerkamp E G , De Vries A C 
Published: March 2007

Abstract
The ultrasonographic measurement of abdominal aortic aneurysm (AAA) must be accurate as the decision on elective repair will usually be based on such results. To detect expansion, measurements must be comparable. The interobserver variation of ultrasonographic measurement of infrarenal aortic aneurysms under standardized conditions is described.
Local recurrence after simple mastectomy
Authors: O'Rourke S , Galea M H , Morgan D , Euhus D , Pinder S , Ellis I O , Elston C W , Blamey R W 
Published: March 2007

Abstract
A retrospective study was carried out to determine the clinical significance of local recurrence after simple mastectomy and node biopsy for primary operable breast cancer, without postoperative irradiation or systemic adjuvant therapy. Local recurrence was defined as a histologically proven lesion in or deep to the mastectomy skin flaps. A total of 966 patients with a median follow-up of 7 years were reviewed. Of these, 223 (23 per cent) developed local recurrence but half the tumours were small single lesions; 70 women had multiple discrete lesions and 21 diffuse carcinomatous dermal infiltration. Local recurrence showed significant associations with tumour grade, nodal status and the presence of lymphovascular invasion in the primary tumour. A predictive index containing these three variables was constructed. Adjuvant irradiation of the flaps is recommended for patients with high scores; such women would otherwise have a 39 per cent chance of developing local recurrence by 5 years. Different types of local recurrence have different chances of responding to local therapy: 13 per cent of single local recurrences, 32 per cent of multiple spot recurrences and 70 per cent of the diffuse type failed to respond to local therapy. Local recurrence predicts reduced patient survival.
Influence of epidermal growth factor and interferon γ on healing of oesophageal corrosive burns in the rat
Authors: Berthet B , Di Costanzo J , Arnaud C , Choux R , Assadourian R 
Published: March 2007

Abstract
A study was performed to attempt to modify the healing response to severe oesophageal corrosive burns to prevent complications. The study was performed on four groups each of 15 Wistar rats: a control group, an untreated group and groups given epidermal growth factor (EGF) alone or EGF for 5 days and interferon (IFN) γ from the sixth to 20th day. In the last three groups an oesophageal lesion was induced with 2–5 moll−1 sodium hydroxide solution. The efficacy of treatment was assessed on days 2, 5 and 20 by measurement of weight gain, oesophageal internal lumen, stenosis index (wall thickness: lumen diameter) and collagen production. On day 5, collagen synthesis was significantly (P&lt;0.05) higher in rats given EGF than in the untreated group. On day 20, no significant difference was seen in weight gain between the control rats and either treated group and stenoses were present in all untreated rats and in none of the treated group. The stenosis index on day 20 was lower in the groups given EGF and EGF-IFN-γ than in untreated rats (P&lt;0.05) and collagen production was significantly (P&lt;0.05) lower in the group given EGF and IFN-γ than in the other animals. The sequential use of EGF and IFN-γ significantly reduced the frequency of residual stenosis.
Radical transhiatal oesophagectomy under direct vision
Authors: Alderson D , Courtney S P , Kennedy R H 
Published: March 2007

Abstract
Modified transhiatal oesophagectomy is described for the resection of tumours affecting the distal third of the oesophagus. The operation confers the advantages of radical resection and the ability to undertake the procedure under direct vision. Forty patients with a median age of 67 years underwent this operation during a 36-month period and were followed for up to 42 months after surgery. The hospital mortality rate was one of 40 patients and the median postoperative stay 10 days. All but four patients left hospital within 2 weeks of operation. Eighteen of 30 patients were alive at 12 months and seven of 18 at 24 months after operation. Only two patients are known to have developed local recurrence in the tumour bed. This procedure confers the advantages of a radical approach under direct vision and incorporates the principles of near-total oesophagectomy and cervical anastomosis in the treatment of oesophageal cancer.
Results of major hepatectomy for large primary liver cancer in patients with cirrhosis
Authors: Capussotti L , Borgonovo G , Bouzari H , Smadja C , Grange D , Franco D 
Published: March 2007

Abstract
Major hepatectomy is associated with a high operative risk in patients with cirrhosis. Between June 1983 and December 1991, 33 cirrhotic patients, 31 with good liver function, underwent major liver resection for a large hepatic primary cancer. The hospital mortality rate was 3 per cent; the only death resulted from liver failure after extended right hepatectomy. None of the patients had variceal bleeding during the postoperative period. Survival rates at 1, 2 and 3 years were 66, 43 and 37 per cent respectively. Recurrence was the most common reason for late death. These results suggest that the operative risk of major hepatectomy in cirrhotic patients with a large tumour and good liver function is comparable to that of minor liver resection. Late survival is also similar to that of patients with a small tumour. Cirrhotic patients with hepatic carcinoma and good liver function are suitable for major hepatectomy.
Radical excision of sacrococcygeal tumours
Authors: Anson K M , Byrne P O , Robertson I D , Gullan R W , Montgomery A C V 
Published: March 2007

Abstract
Large sacrococcygeal tumours are rare and remain a difficult management problem. Chordomas are one of the most common tumours in this region and may account for 30–40 per cent of postrectal tumours. Four patients aged between 22 and 66 years, three with chordomas and one with a schwannoma, are described. Each was managed by a combined general and neurosurgical approach. Major radical excision of the tumour involving high amputation of the sacrum and lower sacral nerve root division was performed. These large lesions can be radically excised with limited postoperative morbidity and excellent preservation of neurological function, including sphincter control, provided that one S2 nerve root is left intact.
Anal endosonography for identifying external sphincter defects confirmed histologically
Authors: Sultan A H , Kamm M A , Talbot I C , Nicholls R J , Bartram C I 
Published: March 2007

Abstract
Defects of the external anal sphincter have traditionally been diagnosed by palpation, anal manometry and electromyography (EMG), but anal endosonography enables clear imaging of both the internal and external sphincter muscles. A study was performed to validate the interpretation of ultrasonographic images of external sphincter defects using histology as a ‘gold standard’. In addition the accuracy of clinical examination, manometry, EMG mapping and anal endosonography in the diagnosis of sphincter defects were compared prospectively. Twelve consecutive patients with faecal incontinence (11 women, one man; mean age 46 (range 30–64) years) who required sphincter repair underwent clinical assessment, anal manometry, concentric-needle EMG mapping and anal endosonography before surgery. The endosonographer was unaware of the history or results of physiological tests and the surgeon performing the repair was blind to the ultrasonographic findings. At operation most or all of the suspected defect was excised and examined histologically. The pathologist was unaware of the endosonographic or operative findings at the time of reporting. Combined operative and histological examination identified an external sphincter defect in nine of the 12 patients. Anal endosonography correctly identified all nine defects and the three normal sphincters. The accuracy of clinical examination was 50 per cent and that of both EMG and anal manometry 75 per cent. In addition, anal endosonography identified a defect of the internal anal sphincter in eight patients. External sphincter defects identified by endosonography have not been previously verified histologically. Precise sphincter assessment is mandatory for the correct management of faecal incontinence. Anal endosonography is more accurate than clinical and conventional physiological methods and also provides information on the internal sphincter.
Management of non-palpable breast lesions detected mammographically
Authors: Allen M J , Thompson W D , Stuart R C , Gill P T , Walton E W , Karczenski K , Hoffman J , Peel A L G 
Published: March 2007

Abstract
A total of 212 consecutive fine-wire localization breast biopsies in 202 patients were performed on impalpable mammographically suspicious lesions. Preoperative fineneedle aspiration cytology was performed on 159 lesions and was valuable in planning the extent of the fine-wire localization biopsy. All 212 target lesions were accurately biopsied during the initial surgery. Overall, 134 lesions were malignant and 78 benign (benign:malignant ratio 1:1·72), with fewer biopsies for benign lesions performed in screened patients (benign:malignant ratio 1:2·43) than in those with symptoms (ratio 1:1). Breast conservation was achieved in 72 patients (80 per cent) with screen-detected in situ or invasive carcinoma and in 19 of 37 presenting via a symptomatic clinic. In 160 of 202 patients (79 per cent) the initial fine-wire localization biopsy was diagnostic and therapeutic.
Effects of minimally invasive surgery on hypochlorous acid production by neutrophils
Authors: Carey P D , Wakefield C H , Thayeb A , Monson J R T , Darzi A , Guillou P J 
Published: March 2007

Abstract
The production of chlorinated oxidants such as hypochlorous acid is a central antimicrobial and immunoregulatory function of neutrophils. Neutrophil hypochlorous acid production was compared in patients undergoing uncomplicated laparoscopic surgery (group 1) and those submitted to conventional open surgery (group 2). Preoperative peak hypochlorous acid production was similar in the two groups (mean(s.e.m.) 0·60(0·05) versus 0·69(0·06) nmol/min respectively). In group 2, mean (s.e.m.) neutrophil hypochlorous acid production fell significantly on day 1 after surgery (0·36(0·05) nmol/min; P&lt;0·01) but this did not occur in group 1 (0·63(0·07) nmol/min). By day 6 hypochlorous acid kinetics had returned to preoperative levels in both groups. Minimally invasive surgery is less disruptive of neutrophil function than conventional open procedures.