bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective randomized study of preoperative bowel cleansing for patients undergoing colorectal surgery
Authors: Wolters U , Keller H W , Sorgatz S , Raab A , Pichlmaier H 
Published: March 2007

Abstract
Three different methods of preoperative bowel preparation were tested in a prospective randomized trial examining efficacy and morbidity. In all, 163 patients were treated by gut irrigation with Ringer's lactate, Prepacol or polyethylene glycol (PEG). Fluid retention, cleansing effect, postoperative complications and subjective acceptance were documented. Relevant weight gain and decrease in haematocrit indicating fluid retention were seen only after the use of Ringer's lactate. There were no significant differences in bowel cleansing. In the Prepacol group the postoperative complication rate was significantly increased. Prepacol was tolerated best, with few side-effects. PEG was better tolerated than Ringer's lactate, but vomiting occurred in 2 and 21 per cent of patients respectively. PEG is most suitable for bowel preparation in patients undergoing colorectal surgery.
Radical resection for ampullary carcinoma: Long-term results
Authors: Sperti C , Pasquali C , Piccoli A , Sernagiotto C , Pedrazzoli S 
Published: March 2007

Abstract
Of 36 patients with carcinoma of the ampulla of Vater who underwent surgery between 1971 and 1990, 31 had a radical operation. There was one operative death. The overall 5- and 10-year survival rates were 56 and 37 per cent respectively. Survival was significantly influenced by tumour stage (P = 0·0002), lymph node status (P = 0·006) and the degree of differentiation of the lesion (P = 0·01). Three patients developed local recurrence after local excision of the tumour. Local or hepatic recurrence was common, even 5 years after pancreatoduodenectomy (four of 18 patients who suffered relapse). Radical resection can be curative in selected patients with ampullary carcinoma but late recurrence suggests the need for careful lifelong follow-up.
Practical score to aid decision making in doubtful cases of appendicitis
Authors: Ramirez J M , Deus J 
Published: March 2007

Abstract
During recent years different procedures have been used to assist in diagnosis of questionable cases of appendicitis. Among these methods, there are few scoring systems that have been shown to be effective. The aim of this study was to create a scoring system and to test its accuracy in the preoperative diagnosis of acute appendicitis. Clinical data from 360 patients who had undergone appendicectomy were collected to identify attributes that distinguished patients having a negative laparotomy from those with appendicitis. Seven independent criteria were identified. Using Bayesian methodology a weight was given to each criterion and an overall score calculated. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was applied prospectively to 166 consecutive patients; 134 had appendicitis and 32 a normal appendix (19·3 per cent error diagnosis). For the 166 patients the method suggested surgery in 113, 107 (94·7 per cent) of whom were found to have appendicitis. The system suggested observation in hospital in 38 cases. For the whole group the scoring system showed a sensitivity of 80 per cent and specificity of 81 per cent. Scoring systems from a local database could become the ideal complementary method in the diagnosis of suspected acute appendicitis.
Prognostic factors and survival of patients aged less than 45 years with colorectal cancer
Authors: Heys S D , Sherif A , Bagley J S , Brittenden J , Smart C , Eremin O 
Published: March 2007

Abstract
Colorectal cancers in 92 patients aged 45 years and under presenting over a 20-year period (1970–1990) were studied. A delay of more than 4 months in presentation was seen in 27 per cent of patients. All underwent surgery, 14 per cent emergency and 86 per cent elective, and follow-up was available for 91 patients. Overall, 14 per cent of patients had Dukes A tumours, 32 per cent Dukes B, 36 per cent Dukes C and 18 per cent Dukes ‘D’. Local recurrence occurred in eight (9 per cent) of the 92 patients and overall 5- and 10-year survival rates were 61 and 59 per cent. Multivariate analysis identified independent risk factors for local recurrence to be mucinous carcinoma (relative effect 4·9) and the presence of intramural vascular invasion by tumour (relative effect 9·4). For overall survival, independent risk factors were involvement of the regional lymph nodes by tumour (relative effect 2·0), extramural invasion by tumour cells (relative effect 3·0), tumour size (relative effect 1·8) and the presence of metastatic disease at initial diagnosis (relative effect 3·7).
Colorectal cancer surveillance in patients with ulcerative colitis
Authors: Jonsson B , Åhsgren L , Andersson L O , Stenling R , Rutegåd J 
Published: March 2007

Abstract
In prospective study carried out between 1977 and 1991, 131 patients with ulcerative colitis from an area of 65 000 inhabitants were followed by clinical visits and regular colonoscopy with biopsy. At the end of the study 58 patients had had total colitis for more than 10 years, 38 had left the programme (16 after radical operations, nine because of death – one from colitis, one from carcinoma – and 13 for other reasons) and 632 colonoscopies had been performed. Colorectal carcinoma was diagnosed in four patients, of whom two were included in the programme with a diagnosis of cancer. Dysplasia was diagnosed in 24 patients, other than those with malignancy; in four this was of high grade. Carcinoma and dysplasia occurred mainly in the left colon and in patients with total colitis. The surveillance programme was resource consuming and the cost-benefit must be questioned.
Thoracoscopic evaluation of the diaphragm in patients with knife wounds of the left lower chest
Authors: Nel J H T , Warren B L 
Published: March 2007

Abstract
The role of thoracoscopy in assessing the status of the diaphragm in penetrating knife wounds of the left lower chest was studied prospectively in 55 patients. Those with positive thoracoscopic findings (n = 22) proceeded to exploratory laparotomy and those with an uninvolved diaphragm (n = 32) were observed. Thoracoscopy was inconclusive in one patient and two were lost to follow-up. With operative findings or 30-month follow-up data as evaluation endpoints, thoracoscopy in 52 patients was 100 per cent sensitive, 90 per cent specific and 94 per cent accurate. A projected negative laparotomy rate of 63 per cent would have occurred with a policy of mandatory laparotomy; using thoracoscopy the actual rate was 6 per cent. Thoracoscopy is a safe and reliable method of evaluating the diaphragm in patients with left lower thoracic stab wounds.
Laparoscopic cholecystectomy for biliary pancreatitis
Authors: Tate J J T , Lau W Y , Li A K C 
Published: March 2007

Abstract
A prospective study was undertaken to assess the technical difficulty of early laparoscopic cholecystectomy for acute biliary pancreatitis. Patients underwent early endoscopic retrograde cholangiography (ERC) and laparoscopic cholecystectomy was performed after signs of clinical improvement. Five steps were assessed during surgery using a visual analogue score. These patients were compared with a control group undergoing elective surgery for chronic symptomatic gallstones. Of 24 patients aged 28–83 (median 60) years, eight had three or more positive signs according to Ranson's criteria. Twenty-three patients underwent successful ERC; seven had choledocholithiasis and were managed endoscopically. Laparoscopic cholecystectomy performed 3–24 (median 7) days after admission was successful in 21 of the 24 patients. The mean(s.d.) operative difficulty score was significantly increased in patients with acute biliary pancreatitis compared with that in the 40 controls (5·4(1·8) versus 3·6(1·4), P &lt; 0·002), particularly for dissection of Calot's triangle (6·5(1·5) versus 3·0(1·6), P &lt; 0·001). A dilated cystic duct was present in over 50 per cent of patients and in seven could not be safely closed with a clip; this finding was not predicted by ERC. Biliary pancreatitis is a further indication for laparoscopic cholecystectomy. Early surgery is safe but technical difficulty is increased. Cystic duct dilatation must be anticipated; an externally tied ligature in continuity is recommended.
National audit of complicated diverticular disease: Analysis of index cases
Authors: Tudor R G , Farmakis N , Keighley M R B 
Published: March 2007

Abstract
Details of 300 patients with complicated diverticular disease from 30 hospitals between 1985 and 1988 were entered into a national audit organized by the Surgical Research Society. Complications present on admission included acute phlegmon (n=104), pericolic abscess (n=34), purulent peritonitis (n=40), large bowel obstruction (n=31), faecal peritonitis (n=23), pericolic abscess complicated by fistula (n=28) and lower gastrointestinal bleeding (n=40). The overall mortality rate was 11·3 per cent (acute phlegmon, 4 per cent; purulent peritonitis, 27 per cent; pericolic abscess, 12 per cent; faecal peritonitis, 48 per cent; large bowel obstruction, 6 per cent; bleeding, 2 per cent; fistula, 4 per cent). Acute phlegmon was treated without operation in 78 patients (75·0 per cent) and by resection in 24 (23·1 per cent). Management of purulent peritonitis generally involved Hartmann's procedure (62 per cent) or resection and primary anastomosis (15 per cent). Similarly, patients with pericolic abscess usually underwent Hartmann's procedure (38 per cent) or resection and primary anastomosis (35 per cent). The principal operation for faecal peritonitis was Hartmann's resection (83 per cent). Large bowel obstruction was managed conservatively in four patients (13 per cent), by Hartmann's procedure in nine (29 per cent), and by resection and primary anastomosis with or without a proximal stoma in 13 (42 per cent). Most patients (82 per cent) with fistula associated with an abscess were managed by resection and primary anastomosis; 90 per cent with acute gastrointestinal bleeding were treated without operation.
The 5-year natural history of complicated diverticular disease
Authors: Farmakis N , Tudor R G , Keighley M R B 
Published: March 2007

Abstract
The natural history of complicated diverticular disease based on details of 300 patients entered into a national audit between 1985 and 1988 is reported. Questionnaires were sent to the general practitioners of 176 patients with this condition 5 years after hospital admission; 120 responded. Of these 120 patients, ten died from recurrent complicated diverticular disease, 29 died from other disorders and 81 remain alive. Forty of 110 patients (excluding those who died from recurrence) are still symptomatic or were so at the time of unrelated death. Thirty-nine patients developed a severe complication after the index admission, 14 of whom had the same complication initially. Of the 77 patients who had initially been managed by sigmoid resection, only two developed recurrent complications compared with 37 of 43 managed conservatively. Of the ten patients who died from recurrent diverticular disease, nine had not undergone sigmoid colectomy at or after the original admission. These data argue for interval sigmoid colectomy in most patients who initially present to hospital with complicated diverticular disease to prevent later development of potentially lethal complications.
Unconjugated faecal bile acids in familial adenomatous polyposis analysed by gas-liquid chromatography and mass spectrometry
Authors: Barker G M , Radley S , Davis A , Imray C H E , Setchell K D R , O'Connell N , Donovan I A , Keighley M R B , Neoptolemos J P 
Published: March 2007

Abstract
Previous studies have suggested reduced formation of secondary bile acids in patients with familial adenomatous polyposis (FAP). Developments in the collection, extraction and analysis of faecal bile acids as well as in the accurate diagnosis of FAP by DNA markers prompted reinvestigation of this hypothesis. The median (interquartile range (i.q.r.)) faecal bile acid concentration (3·69 (1·66–5·36) μmol per g dry weight) and daily excretion rate (60·5 (29–149) μmol per g per 24 h) in ten patients with FAP were similar to those of nine control subjects (3·31 (0·65–8·38) μmol per g dry weight and 30·1 (7·9–228) μmol per g per 24 h). Although the median (i.q.r.) concentration of only one bile acid (12-oxo-lithocholic acid) was significantly different between patients with FAP and controls (49 (34–70) versus 0 (0–20) nmol per g dry weight, P=0·006), the derivatives of chenodeoxycholic acid (3·35 (1·76–5·32) versus 0·51 (0·13–2·37) μmol per g dry weight, P=0·02) and cholic acid (1·63 (0·42–2·34) versus 0·80 (0·13–3·57) μmol per g dry weight, P=0·006) were increased in those with polyposis. These results show increased bacterial biotransformation of faecal bile acids in patients with FAP.
Increased gut permeability after multiple trauma
Authors: Pape H-C , Dwenger A , Regel G , Auf'm'Kolck M , Gollub F , Wisner D , Sturm J A , Tscherne H 
Published: March 2007

Abstract
Gut permeability was studied in multiply injured patients with respect to the development of multiple organ failure (MOF). Two groups were defined according to MOF score (threshold 10 points) as to whether MOF developed (group 1; n = 11, four deaths) or did not (group 2; n = 21, no death). Gut permeability was determined from the ratio of urinary excretion of enterally administered lactulose and mannitol. Serum elastase concentrations were also determined. Mean(s.e.m.) gut permeability was abnormal during the entire study (day 1: group 1 5·1(2·1) versus group 2 10·6(4·1) (P not significant; P &lt; 0·001 versus normal volunteers, 0·56(0·24)). An increase on days 3 and 5 correlated with serum elastase levels only in patients in group 1 (rs = 0·71, P &lt; 0·01). Severe injury leads to increased intestinal permeability, which is related to a systemic inflammatory response.
Comparison of radioligand assay and immunostaining for epidermal growth factor receptor in human breast cancer
Authors: Hastrich D J , Dunn J M , Nicholson S , Newcomb P , Farndon J R 
Published: March 2007

Abstract
Epidermal growth factor (EGF) receptor status is a useful prognostic indicator in women with breast cancer. Lack of standardization and correlation of methodology for the detection of EGF receptor has hampered its further evaluation. EGF receptor status was ascertained by immunohistochemistry and radioligand assay in 120 breast cancers. Of 52 tumours negative for EGF receptor on radioligand assay, 47 were negative on immunohistochemistry and, of 68 tumours positive for the receptor on assay, 52 were positive on immunohistochemistry. If the more widely evaluated radioligand assay is assumed to be the ‘gold standard’, immunohistochemistry has a sensitivity of 81 per cent and a specificity of 91 per cent.
Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer
Authors: Oertli D , Laffer U , Haberthuer F , Kreuter U , Harder F 
Published: March 2007

Abstract
A randomized double-blind trial has shown that, in 160 women with breast cancer undergoing lumpectomy or mastectomy with axillary clearance, perioperative and postoperative administration of tranexamic acid 1 g three times daily resulted in a significant reduction in the mean postoperative drainage volume compared with patients given placebo (283 versus 432 ml, P &lt; 0·001). The frequency of postoperative seroma formation was also decreased by tranexamic acid administration (27 versus 37 per cent, P = 0·2). Haematoma formation was infrequent in both groups and was not altered by administration of tranexamic acid. No infectious complications occurred. Age over 60 years was a significant risk factor for overall wound complications but tumour size and regional lymph node metastases were not. Tranexamic acid may be used to reduce the frequency of postoperative wound complications following surgery for breast cancer.
Prediction of pulmonary complications after transthoracic oesophagectomy
Authors: Nagawa H , Kobori O , Muto T 
Published: March 2007

Abstract
Postoperative pulmonary complications are often fatal in patients with oesophageal cancer. The influence of various preoperative and perioperative risk factors in the prediction of such complications was analysed. Some 170 oesophageal resections performed through a thoracotomy between January 1977 and December 1991 were reviewed. Twenty-two parameters generated from various medical risk categories were studied. Six variables were significant (P &lt; 0·05) on univariate analysis: vital capacity, serum albumin level, partial pressure of carbon dioxide in arterial blood, presence of liver cirrhosis, presence of chronic obstructive airway disease and clinical stage of the tumour. Multivariate discriminant analysis of these six factors identified three as significant, namely vital capacity (P &lt; 0·0001), liver cirrhosis (P = 0·01) and tumour stage (P = 0·01), yielding an equation for assessment of the risk of postoperative pulmonary complications. Calculation of the risk score showed that 42 of 53 patients with pulmonary complications had scores of 0 or more and that 74 of 102 without had scores below 0. The mean risk score was 0·34 for patients with complications and −0·26 for those without. The equation predicted pulmonary complications after transthoracic oesophagectomy with 74·8 per cent accuracy, 79·2 per cent sensitivity and 72·5 per cent specificity. It is concluded that the risk of postoperative pulmonary complications can be accurately assessed in individual patients by calculation of a risk score based on vital capacity, liver cirrhosis and tumour stage.
Surgical management of intrathoracic oesophageal rupture
Authors: Sabanathan S , Eng J , Richardson J 
Published: March 2007

Abstract
Intrathoracic oesophageal rupture is a life-threatening condition that requires early diagnosis and effective treatment if death or serious prolonged illness is to be avoided. Six consecutive patients with intrathoracic oesophageal rupture were treated by debridement and irrigation of the mediastinum and primary suture closure with reinforcement of the suture line by pedicled omentum. The cause of the rupture was Boerhaave's syndrome in five patients and compressed air injury to the oesophagus in one. All but one patient presented more than 24 h after onset of symptoms, with a mean of 38 (range 12–72) h. All the patients recovered well with no postoperative oesophageal leakage. The mean hospital stay was 11·5 (range 9–15) days. Irrespective of the duration of the oesophageal rupture, aggressive resuscitation and prompt primary suture closure with reinforcement of the suture line with a well vascularized pedicled tissue flap is required for optimal results.
Effect of intraoperative manipulation and anaesthesia on lower oesophageal sphincter function during fundoplication
Authors: Johnsson F , Ireland A C , Jamieson G G , Dent J , Holloway R H 
Published: March 2007

Abstract
The variables influencing the intraoperative measurement of lower oesophageal sphincter (LOS) pressure and a new method of assessing the effect of a fundal wrap on LOS function were investigated in 13 patients undergoing fundoplication. All patients had a 360° wrap fashioned around a 50-Fr bougie; four also underwent highly selective vagotomy. The effect of the fundal wrap, independent of LOS pressure, was assessed by inducing LOS relaxation with balloon distension. Preoperative mean(s.e.m.) LOS pressure (14·1(2·6) mmHg) did not correlate with that at the start of operation (11·5(1·5) mmHg). After mobilization of the oesophagus mean(s.e.m.) LOS pressure increased significantly (to 19·8(2·0) mmHg; P &lt; 0·0005) and oesophageal distension elicited LOS relaxation on 16 of 33 occasions. After completion of the wrap there was no further increase in LOS pressure, but LOS relaxation occurred after only five of 33 distensions (P &lt; 0·01). These findings indicate that anaesthesia and intraoperative manipulation during fundoplication have significant effects on LOS function that detract from the validity of intraoperative assessment. They question the rationale of current approaches to intraoperative manometry for the assessment of antireflux surgery.
Chromosome allele loss in colorectal liver metastases and its association with clinical features
Authors: Ding S-F , Delhanty J D A , Zografos G , Michail N E , Dooley J S , Habib N A 
Published: March 2007

Abstract
Molecular genetic changes are better characterized in colorectal carcinoma than in other common adult tumours. Consistent allele losses, or loss of heterozygosity (LOH), on chromosomes 5q, 17p and 18q have been well established. These changes are associated with the prognosis of the disease. Little is known of such changes in liver metastases of colorectal origin. The extent of allelic loss and its association with clinical features were investigated in 19 patients with colorectal liver metastases by using 24 probes to detect restriction fragment length polymorphism. A high frequency of LOH on chromosomes 5q, 17p and 18q was found in these secondary tumours. No consistent loss has so far been shown in any other chromosome. The frequency of allele loss correlated significantly with prognostic features such as the number and size of liver secondaries (P &lt; 0·005), metastasis to the lymph nodes (P &lt; 0·01) and curative or palliative operation (P &lt; 0·02).
Antimicrobial treatment of pancreatic infection in cats
Authors: Widdison A L , Karanjia N D , Reber H A 
Published: March 2007

Abstract
An investigation examined the efficacy of antibiotics in a novel feline model of pancreatic infection in acute pancreatitis. Acute pancreatitis was induced in cats using an established technique. In control animals (no pancreatitis) and cats with pancreatitis, Escherichia coli (104 in 0·1 ml) was placed in the pancreatic duct. Reoperation was performed after 24 h in six controls and six cats with pancreatitis. E. coli was cultured from the pancreas in five control animals and five cats with pancreatitis. Reoperation was performed after 1 week in ten controls, in 11 cats with pancreatitis and in nine with pancreatitis that were treated with cefotaxime (50 mg/kg intramuscularly three times daily) started 12 h after the induction of pancreatitis and administration of E. coli. Pancreatic infection developed in eight cats with pancreatitis compared with none of the cefotaxime-treated animals and none of the controls (P &lt; 0·05). Cefotaxime reached bactericidal levels in pancreatic tissue and juice. In conclusion, ductal administration of E. coli caused pancreatic infection only in cats with acute pancreatitis. Early administration of an appropriate antibiotic was effective in treating pancreatic infection in acute pancreatitis.
Acute scrotal pain complicating familial Mediterranean fever in children
Authors: Eshel G , Vinograd I , Barr J , Zemer D 
Published: March 2007

Abstract
Twenty-nine children with familial Mediterranean fever presented with 39 attacks of acute scrotal pain. Of these, 25 patients had an acute scrotum complicating familial Mediterranean fever and only four had testicular torsion. Scrotal pain was the only manifestation of a familial Mediterranean fever crisis in 36 episodes and in 15 boys scrotal involvement was the first manifestation of the condition. Fourteen patients were treated medically. Of 15 patients who underwent scrotal exploration there were no definite diagnostic findings in 11 and four had testicular torsion. Three cardinal features strongly suggest the diagnosis of acute scrotum in familial Mediterranean fever in a boy of Mediterranean origin with a relevant family history: recurrent scrotal pain or swelling; body temperature above 37·5°C; and gradual onset of pain, usually of more than 12 h duration. Conservative management can safely be undertaken in these boys without fear of losing a salvageable testis.