bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seton treatment of high anal fistulae
Authors: Williams J G , MacLeod C A , Rothenberger D A , Goldberg S M 
Published: March 2007

Abstract
Seventy-four patients who underwent seton treatment of high anal fistulae over a 6-year period have been reviewed. Four different techniques were used: staged fistulotomy (n = 24), cutting seton (n = 13), short-term seton drainage (n = 14) and long-term seton drainage in patients with Crohn's disease (n = 23). Recurrence developed in two patients (8 per cent) undergoing two-stage fistulotomy; two patients (14 per cent) undergoing short-term drainage and nine (39 per cent) of the patients with Crohn's disease. Three patients with Crohn's disease required proctectomy for progressive perianal disease. The remaining 11 patients with Crohn's disease (48 per cent) obtained a good result. None of the patients treated with a cutting seton developed a recurrence. Minor incontinence developed in 13 patients (54 per cent) undergoing two-stage fistulotomy and seven patients (54 per cent) treated with a cutting seton. When sphincter muscle was not divided, five patients (36 per cent) undergoing short-term drainage and six patients (26 per cent) undergoing long-term drainage developed minor incontinence. High complex fistulae can be successfully treated with only minor loss of continence using different seton techniques. In high Crohn's fistulae, long-term seton drainage preserves sphincter function, but recurrence is common if the seton is removed.
Reversal of Hartmann's procedure: Timing and operative technique
Authors: Roe A M , Prabhu S , Ali A , Brown C , Brodribb A J M 
Published: March 2007

Abstract
A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P &lt; 0·05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.
Risk of strangulation in groin hernias
Authors: Gallegos N C , Dawson J , Jarvis M , Hobsley M 
Published: March 2007

Abstract
Although the elective repair of groin hernias is advised to prevent strangulation, the likelihood of this complication occurring is unknown. To quantify this risk, the cumulative probability of strangulation in relation to the length of history has been calculated for inguinal and femoral hernias presenting to this hospital between 1987 and 1989. Of 476 hernias (439 inguinal, 37 femoral), there were 34 strangulations (22 inguinal, 12 femoral). After 3 months the cumulative probability of strangulation for inguinal hernias was 2·8 per cent, rising to 4·5 per cent after 2 years. For femoral hernias the cumulative probability of strangulation was 22 per cent at 3 months and 45 per cent at 21 months. The rate at which the cumulative probability of strangulation increased was in both cases greatest in the first 3 months, suggesting that patients with a short history of herniation should be referred urgently to hospital and given priority on the waiting list.
Surgical management of the thoracic outlet compression syndrome
Authors: Davies A H , Walton J , Stuart E , Morris P J 
Published: March 2007

Abstract
There is some disagreement about whether the first rib should be excised in the presence of a cervical rib for the relief of the thoracic outlet compression syndrome (TOCS). Over a 14-year period (1975–1988) 58 patients have undergone surgery for TOCS. Forty-four patients (76 per cent) had vascular symptoms, 28 (48 per cent) with a neurological component; 11 (19 per cent) had only neurological symptoms. Thirty-six patients (62 per cent) had the first rib excised; 19 (33 per cent) had a cervical rib excised; two (3 per cent) had a division of fibrous bands; and one patient had a large transverse process resected. Follow-up details were available on 53 patients (91 per cent). Overall 38 (72 per cent) were cured of their symptoms, 11 (21 per cent) had a significant improvement, and four (8 per cent) showed no improvement. There was no significant difference between the results following excision of a cervical rib or of a first rib in terms of relief of symptoms. In patients with TOCS who have a cervical rib, excision of the cervical rib alone without excision of the first rib would appear to be an appropriate treatment.
Current management of trauma to the pancreas
Authors: Wilson R H , Moorehead R J 
Published: March 2007

Abstract
This review examines pancreatic trauma and its management in the light of recent experience. The incidence, mechanism, classification, diagnosis, treatment and complications of pancreatic trauma are discussed. The difficulty in establishing the diagnosis is addressed and possible solutions are provided. The case for conservative surgery in the absence of pancreatic duct damage is outlined. The importance of draining all pancreatic injuries is emphasized.
Anti-epithelial membrane antigen monoclonal antibodies and radioimmunolocalization of colorectal cancer
Authors: Yiu C Y , Baker L A , Boulos P B 
Published: March 2007

Abstract
The monoclonal antibodies LICR-LON M8 and 77-1, which react with epithelial membrane antigen, showed a strong reaction with colorectal cancer on immunohistochemistry. In a radioimmunolocalization study in patients with colorectal cancer, 111In-labelled M8 detected 13 of 16 tumour sites present in 16 patients. 111In-labelled 77-1 detected 10 of 15 tumour sites present in 14 patients. The high radioactive background in the liver prevented the detection of hepatic metastases in eight patients (five in the M8 and three in the 77-1 group). The mean(s.d.) tumour to normal colon ratio was 2·5(1·2) for M8 and 1·6(0·5) for 77-1 at day 6 after antibody administration. The mean(s.d.) tumour to blood ratio was 4·9(3·7) for M8 and 3·6(1·5) for 77-1. There was no statistical difference between these results. All scan-positive cancers reacted with M8 and 77-1 on immunohistochemistry. The results suggest that these monoclonal antibodies may have a role in the immunolocalization of colorectal cancer.
Management of haemangioma of the liver: Comparison of results between surgery and observation
Authors: Yamagata M , Kanematsu T , Matsumata T , Utsunomiya T , Ikeda Y , Sugimachi K 
Published: March 2007

Abstract
Cavernous haemangioma of the liver was diagnosed in 33 patients using hepatic angiography between 1978 and 1988. Thirteen of these patients underwent surgery. There were no deaths after operation; morbidity included upper gastrointestinal bleeding in two patients and liver dysfunction in one. The follow-up study showed no evidence of recurrence in any of the 13 patients up to 143 months after operation. In the operated patients, a small haemangioma was left in the liver of two for anatomical reasons, but the size of these tumours showed no change over 3 years. The remaining 20 patients had no specific treatment for haemangioma and were followed up for between 18 months and 8 years. Of these 20 patients, 19 had tumours of &lt; 5 cm in size. As there was no enlargement or rupture of haemangiomas of &lt; 5 cm, it was felt that these could be observed. Cases having a potential for exposure to trauma, rapid tumour growth, or displaying severe symptoms should be considered for surgical treatment; this can be justified due to low morbidity and no mortality.
Operative choledochoscopy in patients with acute cholangitis: A prospective, randomized study
Authors: Lau W Y , Li A K C , Chu K W , Yuen W K , Poon G P , Hwang J S T 
Published: March 2007

Abstract
A prospective, randomized evaluation of operative choledochoscopy was carried out during emergency surgery in patients with acute cholangitis or acute suppurative cholangitis when conservative management had failed. After common bile duct exploration, 79 patients were randomized to have choledochoscopy and 78 patients to the control group. Laboratory and clinical parameters showed that choledochoscopy did not increase the incidence of septicaemia, acute pancreatitis, persistent cholangitis, postoperative wound sepsis, intraperitoneal sepsis and hospital mortality. The incidence of retained common bile duct stones detected by T tube cholangiography performed in the second postoperative week was significantly reduced (P &lt; 0·01) after choledochoscopy. Choledochoscopy detected stones missed by conventional common bile duct exploration in ten patients. It is concluded that choledochoscopy is a safe and effective technique in patients with acute cholangitis and acute suppurative cholangitis.
Pancreatic tissue and ductal pressures in chronic pancreatitis
Authors: Jalleh R P , Aslam M , Williamson R C N 
Published: March 2007

Abstract
To assess the contribution of parenchymal hypertension to pain, pancreatic tissue pressures were measured intraoperatively in 17 patients with chronic pancreatitis and in four other patients undergoing pancreatic surgery (reference group). The technique involved direct fine needle cannulation of the pancreas using a flow infusion system, which measured parenchymal resistance to this infusion. Three to six recordings were obtained at each site. In chronic pancreatitis the pressure (mean ± s.e.m.) was substantially elevated in all regions of the pancreas compared with reference subjects: head (257 ± 59 versus 19 ± 5 mmHg, P &lt; 0·05); body (201 ± 51 versus 13 ± 6 mmHg, P &lt; 0·05) and tail (161 ± 45 versus 11 ± 3 mmHg, P &lt; 0·05). Elevation was greater in areas of calcific disease (281–383 mmHg) than in non-calcific disease (81–120 mmHg, P &lt; 0·05). Mean pancreatic ductal pressure in 10 patients (seven with calcific disease) was 20 ± 4 mmHg. Differential pressure measurements within the pancreas helped determine the extent of resection in six patients with diffuse disease. The greatly increased tissue pressures in chronic pancreatitis, especially in the presence of calcification, suggest a possible ‘compartment syndrome’.
Structural and functional smooth muscle injury after surgical preparation of reversed and non-reversed (in situ) saphenous vein bypass grafts
Authors: Sayers R D , Bell P R F , Watt P A C , Thurston H , Muller S 
Published: March 2007

Abstract
Intimal hyperplasia and isolated stenoses are major factors in determining the long-term patency of reversed and in situ vein grafts. Surgical handling causes functional endothelial damage in reversed vein grafts but the effects of valvulotome use are unknown. Saphenous vein samples were taken after minimal dissection (control), distension with saline, or after the passage of a valvulotome. Rectangular strips of vein were mounted in an organ bath and cumulative noradrenaline (10−8–10−5M) dose contraction curves were performed. Compared with controls there was a significant reduction in the contractile response of both the distended and valvulotome-prepared veins (P &lt; 0·05). Histological studies revealed partial endothelial cell loss in the distended group and total endothelial cell loss with patchy necrosis of the smooth muscle in the valvulotome group. These results suggest that the current use of a valvulotome not only renders the valves incompetent but also seriously damages the function of the smooth muscle layer.
Oxerutins in the prevention of recurrence in chronic venous ulceration: Randomized controlled trial
Authors: Wright D D I , Franks P J , Blair S D , Backhouse C M , Moffatt C , McCollum C N 
Published: March 2007

Abstract
The value of oxerutins [O-(β-hydroxyethyl)-rutosides] in the prevention of venous ulcer recurrence was investigated in a double-blind randomized controlled trial of 138 patients with recently healed chronic venous ulcers. Oxerutins in the form of Paroven 500 mg twice daily or identical placebo were given, and all patients were provided with elastic compression stockings. At follow-up 3 months later, patients were assessed for re-ulceration and for tablet and stocking compliance. Oxerutins (n = 69) and placebo (n = 69) groups were well matched for age, sex, duration of previous ulceration and deep vein thrombosis. Cumulative re-ulceration by life-table analysis at 12 and 18 months was 22 and 32 per cent respectively for placebo, and 23 and 34 per cent respectively for oxerutins (P = 0·93). Recurrence was more frequent in patients who complied with both tablets and stockings, suggesting that compliance was influenced by continued symptoms (P = 0·006). This trial failed to demonstrate that oxerutins influenced ulcer recurrence.
Prospective audit of vascular surgical emergencies in a District General Hospital
Authors: Michaels J A , Galland R B 
Published: March 2007

Abstract
A prospective clinical audit was carried out to assess the volume and distribution of workload generated by vascular surgical emergencies over a 3-month period in a single health district in the UK. Of 53 consecutive patients referred as surgical emergencies with peripheral vascular problems, 45 were referred to a single vascular surgeon, 36 directly from a general practitioner or other specialist and nine from another general surgeon. A total of 39 operations and six radiological procedures were carried out, including 26 vascular reconstructions. To accommodate the 27 non-urgent operations, nine were performed ‘out of hours’ and 17 planned cases were cancelled. A median of five general surgical beds were required throughout the period studied and 11 patients required intensive therapy unit admission for a total of 39 days. It is concluded that vascular surgical emergencies constitute a substantial workload and are being dealt with mainly by a single vascular surgeon who effectively works a one in one rota. Inadequate facilities for urgent vascular surgery lead to a large number of cases being dealt with out of hours and frequent cancellation of routine operations.
Peptide growth factors and wound healing
Authors: Kingsnorth A N , Slavin J 
Published: March 2007

Abstract
Growth factors and cytokines are important signal transducers in wound microenvironments. Experimental data are accumulating rapidly which demonstrate their ability to influence populations of polymorphs and macrophages to migrate to the wound, subsequently to be replaced by synthetic cells which produce collagen and matrix; these events are controlled sequentially at cell receptor level by a variety of locally delivered (paracrine and autocrine) peptides. Preliminary results from clinical trials using recombinant human growth factors to improve cutaneous healing are encouraging. Current research aims to produce growth preparations which can be applied to a wound to accelerate healing.
Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses
Authors: Akyol A M , McGregor J R , Galloway D J , Murray G , George W D 
Published: March 2007

AbstractThe purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean(s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P&lt;0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P&lt;0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.
Mucosal function after ileal mucosal fenestration and colonic autotransplantation
Authors: Campbell F C , Smith D , Waldron B , Tait I , Shirazi-Beechey S , Mullins J , Hopwood D 
Published: March 2007

Abstract
A method of small bowel mucosal augmentation called ileal mucosal fenestration and colonic autotransplantation (IMFCA) was devised and tested in pigs. In this technique, a vascularized mucosal graft was harvested from a 12-cm ileal loop, fenestrated by serial incision and then expanded to 20 cm. A 20-cm colonic loop was isolated and surgical mucosectomy was carried out. The fenestrated ileal mucosal graft was then autotransplanted into the prepared colon and the resulting composite structure was exteriorized as a Thiry-Vella loop. With this technique, ileal mucosal fenestrations healed by lateral epithelial in-growth, giving a new mucosal continuum within the recipient colon. At 60 days after surgery, the surface area of transplanted mucosa exceeded that within the original ileal loop by approximately 85 per cent. At this time, the transplanted mucosa had morphology and capacity for Na+-dependent glucose transport which were indistinguishable from those of control ileal mucosa.
A safe new procedure for high-risk patients with symptomatic gallstones
Authors: Leahy A L , Darzi A W , Murchan P M , O'Gorman S , Tanner W A , Keane F B V , Hamilton S 
Published: March 2007

Abstract
Cholecystectomy is associated with an appreciable mortality rate in elderly high-risk patients. Patients aged over 60 years with symptomatic gallstones, at high operative risk, underwent cholecystotomy under local anaesthesia through a 3-cm incision. Stones were removed and clearance was demonstrated endoscopically and by tube cholecystography. Catheter drainage was continued for 7 days until a further cholecystogram confirmed clearance. The procedure was attempted in 26 patients with concomitant cardiovascular, respiratory or malignant disease. Successful removal of all gallbladder stones was possible in 24 patients. Four patients had common bile duct stones demonstrated on cholecystography, all of which were successfully treated by endoscopic sphincterotomy. All patients are symptom-free at a mean follow-up of 36 weeks with no recurrent stones on ultrasonography.
Effect of biliary infection on common bile duct healing in the rat
Authors: Rozga J , Ahrén B , Andersson R , Emody L , Bengmark S , Wadström T 
Published: March 2007

Abstract
It has been postulated that biliary infection plays a role in bile duct stricture formation. The aim of this study was to verify this hypothesis and to evaluate the effect of biliary infection on common bile duct healing. A 3-mm longitudinal choledochotomy was performed in 120 rats and closed with a continuous 11/0 Ethilon® suture. Common bile duct division with end-to-end anastomosis using interrupted 11/0 Ethilon sutures was performed in another 30 rats. Biliary infection was achieved in half of the animals with retrograde injection of living 046:K1:H31 strain Escherichia coli recovered from the rat colonic content. All rats with choledochotomy, including those with biliary infection, showed no bile leakage at the suture line, and the bursting pressure at the site of choledochotomy exceeded 40 mmHg as early as 24 h. Rats with common bile duct anastomosis alone showed no stricture formation for up to 6 months after operation. All rats with biliary sepsis developed complete occlusion at the anastomosis. On scanning electron microscopy, the biliary epithelium was well preserved in all rats. The study suggests that in rats with biliary sepsis the risk of bile leakage after primary closure of the common bile duct is negligible, but biliary infection may play a critical role in common bile duct stricture formation.
Postgastrectomy osteoporosis
Authors: Tovey F I , Hobsley M , Hall M L , Ell P J 
Published: March 2007

Abstract
Osteoporosis is a recognized complication following partial gastrectomy and is more common than osteomalacia. Recent improvements in the measurement of bone mineral status (dual energy X-ray absorptiometry, DEXA) have assisted in measuring osteoporosis. Sixteen men who had undergone gastrectomy more than 30 years previously were examined. This study reports the effect of calcium supplementation in six patients in whom osteomalacia had been excluded and who showed abnormally low bone mineral densities on DEXA scanning. Calcium supplementation for 6 months (microcrystalline hydroxyapatite, Ossopan® 8–32 g per day) produced no significant advantage for the treatment group at any site measured.
Trauma audit: experience in north-east Scotland
Authors: Crawford R 
Published: March 2007

Abstract
The management of 125 patients with trauma treated at Aberdeen Royal Infirmary from 1 January 1988 has been analysed using a microcomputer-based hospital trauma registry incorporating trauma and injury severity scores (TRISS) methodology. These patients fulfilled the North American Major Trauma Outcome Study (MTOS) inclusion criteria and were the first for whom data were available. Sixty-six patients had multiple injuries, of whom 52 were suffering from major trauma (defined as an injury severity score of 16 or greater). There were 14 deaths in the series, three (21 per cent) of which were considered to be preventable. Surgery was required in 84 (67.2 per cent) patients, of whom 59 (70 per cent) were operated on by a consultant or senior registrar. Five of six critically injured patients who died from their injuries were operated on by a consultant.
Factors influencing local recurrence and survival in patients with soft tissue sarcoma of the upper limb
Authors: Serpell J W , Ball A B S , Robinson M H , Fryatt I , Fisher C , Thomas J M 
Published: March 2007

Abstract
Fifty-one patients with soft tissue sarcoma of the upper limb were studied to identify risk factors for local recurrence and survival. More than half (53 per cent) of the patients referred had locally recurrent disease. The flexor aspect of the forearm was the most common site of origin. The majority of patients were managed by a combination of conservative surgery and radical radiotherapy. Wide or radical excision was achieved in 49 per cent of cases. One-third of patients required partial resection of bone or neurovascular structures; 75 per cent of them had presented with local recurrence after treatment elsewhere. Skin grafts and flap repairs were used more often in patients with local recurrence (P = 0.013) and 20 (74 per cent) of those referred with locally recurrent disease have had no further local relapse. The overall 5-year survival rate of 80 per cent (95 per cent confidence interval 61–90 per cent) supports a policy of conservative surgery. Factors associated with a lower survival rate were deep fixation, origin in the flexor aspect of the forearm, and previous local recurrence. Deep fixation was also associated with an increased risk of local recurrence. Referral to a specialist unit at the time of initial presentation may result in lower rates of local recurrence and may improve the survival rate.