bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver transplantation in patients with fulminant hepatic failure
Authors: González E Moreno , García G I , Loinaz S C , Gómez S R , González-Pinto I , Hernández G-G D , Jiménez R C , Maffettone V , Pérez-Cerdáa F , Cisneros A C , Ibáñez A J 
Published: March 2007

Abstract
Fulminant hepatic failure without liver transplantation is associated with a high mortality rate (80–100 per cent). Some 254 liver transplantations were performed on 202 patients between April 1986 and February 1992. Of these, 26 patients had fulminant hepatic failure. The median age was 31·5 (range 3–60) years. Reduced-size grafts were used in seven patients. The peroperative mortality rate was six of 26 patients, and five patients died during follow-up. Ten patients underwent retransplantation and two a second retransplant. The overall mortality rate was 16 of 26 and actuarial survival rate was 62·7 per cent at 12 months and 48·7 per cent at 36 months. The peroperative mortality rate is relatively high but liver transplantation is currently recommended as a last-resort treatment for patients with fulminant hepatic failure in the absence of response to medical treatment.
Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: A reappraisal
Authors: Wu C-C , Ho Y-Z , Ho W Lin , Wu T-C , Liu T-J , P'Eng F-K 
Published: March 2007

Abstract
Transcatheter arterial chemoembolization (TACE) improves the treatment of hepatocellular carcinoma (HCC) by causing tumour necrosis and shrinkage. Fifty-two patients with resectable large HCC (defined as a maximal tumour diameter of 10 cm or more) were prospectively randomized into two groups: group 1 comprised 24 patients who had 1–5 sessions of TACE before operation; group 2 consisted of the other 28 patients, on whom surgery was performed without delay. Tumour volume was reduced to a mean(s.d.) of 42·8(15·3) per cent in 16 patients in group 1, but remained unchanged in four and increased in size in a further four. Patients in group 1 had a slightly longer operating time (5·5 versus 4·6 h, P = 0·09), a higher rate of concomitant resection of adjacent organs (58 versus 25 percent, P = 0·03) and a higher rate of histological invasion to these organs (33 versus 4 per cent, P = 0·01). No difference was found between the two groups in operative blood loss, operative morbidity and mortality rates, and pathological staging. The disease-free survival rate in the two groups was similar, but the incidence of extrahepatic cancer recurrence was higher in group 1 (57 versus 23 per cent, P = 0·03). The actuarial survival rate was also significantly worse in group 1 when determined from the time of detection of the tumour (P = 0·03) or from operation (P = 0·01). It is concluded that preoperative TACE for resectable large HCC should be avoided because it does not provide complete necrosis in large tumours and results in delayed surgery and difficulty in the treatment of recurrent lesions, without any benefit.
Gastrointestinal Quality of Life Index: Development, validation and application of a new instrument
Authors: Eypasch E , Williams J I , Wood-Dauphinee S , Ure B M , Schmulling C , Neugebauer E , Troidl H 
Published: March 2007

Abstract
At present, an instrument for measuring the quality of life, specifically for patients with gastrointestinal disease, is not available. A new instrument for gastrointestinal disorders that is system-specific has been developed in three phases. In the first phase, questions were collated and then tested on 70 patients with gastrointestinal diseases and those that worked well were retained. In the second phase, the questions were modified and tested on 204 patients and the results verified by international experts. The instrument was also validated against other generic measures of quality of life. During the third phase, the instrument was validated with 168 normal individuals. Reproducibility was tested on 25 patients with stable gastrointestinal disease and responsiveness was tested on 194 patients undergoing laparoscopic cholecystectomy. The result is a bilingual (German and English) questionnaire containing 36 questions each with five response categories. The responses to questions are summed to give a numerical score. It is concluded that the Gastrointestinal Quality of Life Index (GIQLI) is ready to be used in clinical practice and research.
Effect of ibuprofen on the acute-phase response and protein metabolism in patients with cancer and weight loss
Authors: Preston T , Fearon K C H , McMillan D C , Winstanley F P , Slater C , Shenkin A , Carter D C 
Published: March 2007

Abstract
The aim of this study was to determine whether administration of the non-steroidal anti-inflammatory agent ibuprofen might attenuate the acute-phase response in patients with colonic cancer. Cytokines and acute-phase proteins were measured before administration of ibuprofen and again 3 days later, when protein synthesis was measured using 15N-glycine. In patients with cancer, ibuprofen caused a significant reduction in the plasma concentration of all five acute-phase proteins studied. Although interleukin 6 levels were raised, they did not change following administration of ibuprofen. Unlike the situation in patients with cancer who did not receive ibuprofen, whole-body protein kinetics were similar to those of control subjects in patients with cancer who received ibuprofen. Whether or not ibuprofen had been administered, non-export hepatic protein synthesis rates were significantly lower in patients with than in those without cancer. These results suggest that short-term administration of ibuprofen can attenuate accelerated whole-body protein kinetics and the acute-phase response in patients with advanced cancer.
Treatment of lymphocele in renal transplant recipients by laparoscopic fenestration after transcutaneous staining
Authors: Schilling M , Abendroth D , Kunz R 
Published: March 2007

Abstract
Lymphocele is a rare cause of impairment of graft function after renal transplantation. Treatment ranges from external drainage to laparoscopic internal marsupialization. A therapeutic approach to the treatment of symptomatic lymphocele is described, which employs external drainage, if necessary followed by methylene blue staining and laparoscopic internal drainage, should conservative treatment fail. Five patients developed post-transplant lymphocele of varying size and were treated according to this protocol. Identification of the blue lymphocele at laparoscopy was straightforward and complete marsupialization was performed. After a mean follow-up of 8·4 months all patients are free from symptoms and have well functioning grafts.
Role of intraoperative cholangiography in laparoscopic cholecystectomy
Authors: Madhavan K K , MacIntyre I M C , Wilson R G , Saunders J H , Nixon S J , Hamer-Hodges D W 
Published: March 2007

Abstract
The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.
Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledocholithiasis
Authors: Cox M R , Wilson T G , Toouli J 
Published: March 2007

Abstract
The development of laparoscopic cholecystectomy has created a dilemma in the management of choledocholithiasis. A number of options exist, including endoscopic sphincterotomy (ES) before laparoscopic cholecystectomy in patients with suspected common bile duct (CBD) calculi, laparoscopic bile duct exploration, open CBD exploration and postoperative ES. None of these options has emerged as ideal or universally acceptable. An alternative technique, peroperative ES, has been developed. A prospective assessment of the use of peroperative ES in 13 patients in whom choledocholithiasis was demonstrated with operative cholangiography is presented. Eleven patients had successful ES and clearance of stones. The CBD could not be cannulated in one patient, and an adequate ES for stone extraction could not be performed in the remaining patient. Both procedures were converted to open CBD exploration. Complications were mild postoperative pancreatitis (two patients) and pulmonary atelectasis (one). The median total operating time was 165 min and the median postoperative hospital stay was 3 days. Peroperative ES at the time of laparoscopic cholecystectomy provides a safe technique for clearance of the CBD.
Bile duct injury and bile leakage in laparoscopic cholecystectomy
Authors: McMahon A J , Fullarton G , Baxter J N , O'Dwyer P J 
Published: March 2007

Abstract
The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.
Faecal occult blood testing and colonoscopy in the surveillance of subjects at high risk of colorectal neoplasia
Authors: Robinson M H E , Kronborg O , Williams C B , Bostock K , Rooney P S , Hunt L M , Hardcastle J D 
Published: March 2007

Abstract
Colonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia but the procedure is expensive, time consuming and occasionally hazardous. Faecal occult blood tests can be prepared at home and are cheap, simple and safe. Hemeselect is an immunological faecal occult blood test that is more sensitive for colorectal cancer than Haemoccult. The aim of this study was to determine the sensitivity of the Hemeselect test for asymptomatic colorectal neoplasia in subjects at high risk of the disease who were undergoing colonoscopy, thus assessing its suitability as an alternative means of screening high-risk groups. A total of 919 asymptomatic subjects were asked to complete Hemeselect tests. These were completed satisfactorily by 808 individuals (compliance rate 88 per cent) and were positive in 164 patients (20 per cent). At colonoscopy 11 cancers were detected in ten patients (seven Hemeselect positive) and 36 (16 Hemeselect positive) had at least one adenoma 1 cm or more in diameter. The test sensitivities of Hemeselect for carcinoma and large (1 cm or more) adenomas were 70 and 44 per cent respectively. In a subset of 417 subjects who also completed Haemoccult tests, the sensitivities were 33 and 18 per cent. Hemeselect specificity is 88 per cent compared with 98 per cent for Haemoccult. While the sensitivity of Hemeselect is higher than that of Haemoccult, it is still insufficient to replace colonoscopy in high-risk groups.
New method to evaluate the therapeutic value of lymph node dissection for gastric cancer
Authors: Sasako M , McCulloch P , Kinoshita T , Maruyama K 
Published: March 2007

Abstract
The results of 1281 potentially curative resections for advanced gastric cancer performed at the National Cancer Center Hospital between 1972 and 1986 were studied using a novel approach which circumvents the stage migration phenomenon. The incidence of metastasis and the 5-year survival rate of patients with positive nodes were calculated independently for each lymph node ‘station’, without any reference to overall pathological nodal stage. The therapeutic value of extended lymph node dissection was estimated by multiplication of incidence of metastasis and percentage 5-year survival rate of patients with metastasis for each station. The incidence of metastasis ranged from 2·4 per cent to 66 per cent and the 5-year survival rate of affected patients from 0 to 58·7 per cent in perigastric stations, depending on the site of the primary tumour. The incidence of metastasis was between 3·0 per cent and 44·4 per cent in the second tier of nodes (n2), and the 5-year survival rate ranged from 0 per cent to 47·5 per cent. The majority of second-tier stations showed evidence of benefit from node dissection.
Preoperative assessment of lymph nodes in the prediction of disease spread and outcome in cancer of the thoracic oesophagus
Authors: Matsubara T , Ueda M , Nakajima T 
Published: March 2007

Abstract
Prospective assessment of lymph node status, based on the findings of computed tomography, external ultrasonography and palpation, was compared with clinical results in 179 patients who underwent oesophagectomy with systematic node dissection. Preoperative findings for each node group were classified into four grades: involvement not suspected (−); possible involvement (±); probable involvement (+); and definite involvement (++). When only (++) or (+) assessment was categorized as positive, the specificity was more than 94 per cent, although the sensitivity was less than 40 per cent. The preoperative assessment correlated significantly with the incidence of node involvement (P &lt; 0·02), the degree of lymphatic invasion (P &lt; 0·0001) and outcome after operation. For patients with all nodes assessed as (−), the 5-year survival rate was 70 per cent, compared with 26 per cent for those with nodes assessed as (+), P = 0·001. Preoperative assessment provided useful information on nodal status.
High amplification of the hst-1 gene correlates with haematogenous recurrence after curative resection of oesophageal carcinoma
Authors: Chikuba K , Saito T , Uchino S , Sato K , Miyahara M , Tsuda H , Hirohashi S , Kobayashi M 
Published: March 2007

Abstract
Amplification of the hst−1 gene was examined in 82 patients with oesophageal carcinoma by dot blot hybridization to assess the potential of haematogenous recurrence after curative resection. Intensity of amplification was considered negative (one- to twofold increase) in 45 patients, low (three-sixfold increase) in 19 and high (greater than sevenfold) in 18. Haematogenous recurrence after curative resection was found in seven of eight patients with high amplification and was significantly higher in such patients than in those without amplification (P&lt;0·05). The finding that sevenfold or greater amplification of the hst-l gene seems to be associated with haematogenous recurrence of oesophageal cancer after resection may serve to assess the clinical outcome.
Effect of starch-containing glove powder on wound healing in the rat
Authors: Corless D J , Holland J , Wastell C 
Published: March 2007

Abstract
The effect of the starch-containing powder Bio Sorb on wound healing was examined in an immunocompetent and a T cell-deficient animal model. Wounds were tested by tensionometry to give values of resilience, ultimate strength, toughness and extension. Starch significantly decreased the resilience (P &lt; 0·03), ultimate strength (P &lt; 0·004), and toughness (P &lt; 0·006) of wounds in the immunocompetent model but was not shown to affect the healing of wounds in T cell-depleted animals. When the uncontaminated wounds of the two groups were compared, those from T cell-depleted animals were tougher (P &lt; 0·04) and less extensile (P &lt; 0·0002). These results suggest that starch impairs wound healing by its effect on the T cell-mediated immune system, and that this system may also be involved in regulation of the reparative process because its absence leads to tougher wounds.
Morbidity and mortality after hepatic resection of metastases from colorectal cancer
Authors: Doci R , Gennari L , Bignami P , Montalto F , Morabito A , Bozzetti F , Bonalumi M G 
Published: March 2007

Abstract
A review was carried out of morbidity and mortality after hepatic resection for metastatic colorectal cancer in 208 consecutive patients who underwent this procedure between 1980 and 1992. Overall postoperative morbidity and mortality rates were 35 and 2·4 per cent respectively. The major morbidity rate was 18 per cent, the main complications being intra-abdominal sepsis, biliary fistula and haemorrhage. Of the different factors examined, morbidity was significantly related to the extent of liver resection (53 versus 21 per cent after major and minor resections respectively), amount of blood transfused (18 versus 52 per cent for no transfusion and more than 300 ml transfused respectively) and the date of the operation (53 versus 24 per cent before and after 1986 respectively). Multivariate analysis showed that only the extent of hepatic resection and the period at which surgery was performed retained their statistical significance. These data support the opinion that surgical treatment of hepatic metastases from colorectal cancer is an effective procedure with acceptable mortality and morbidity rates. An extensive experience of hepatic surgery is, however, necessary to optimize results.
Lymph node metastases in carcinoma of the head of the pancreas region
Authors: Nakao A , Harada A , Nonami T , Kaneko T , Murakami H , Inoue S , Takeuchi Y , Takagi H 
Published: March 2007

Abstract
Histopathological examination of lymph node metastatic involvement in 139 specimens obtained from patients who underwent pancreatoduodenectomy or total pancreatectomy combined with wide resection of lymph nodes was performed, to clarify the critical areas of lymph node dissection in patients with carcinoma of the head of the pancreas region. Perigastric lymph node involvement in patients with carcinoma of the head of the pancreas was 14 per cent, in those with carcinoma of the distal bile duct 0 per cent and in those with carcinoma of the papilla of Vater 4 per cent. Para-aortic lymph node involvement in patients with carcinoma of the head of the pancreas, the distal bile duct and the papilla of Vater was 26, 9 and 0 per cent, respectively. On the basis of these results, pylorus-preserving pancreatoduodenectomy is indicated in almost all patients with carcinoma of the distal bile duct and the papilla of Vater. In patients with carcinoma of the head of the pancreas, however, wide dissection of lymph nodes, including para-aortic lymph nodes, should be carried out because of the relatively high incidence of para-aortic lymph node involvement.
Risk-adjusted analysis of surgeon performance: A 1-year study
Authors: Copeland G P , Sagar P , Brennan J , Roberts G , Ward J , Cornford P , Millar A , Harris C 
Published: March 2007

Abstract
A 1-year prospective analysis was undertaken of all non-day-case general surgery in a district general hospital. Using the Physiological and Operative Severity Score for the en Umeration of Mortality and Morbidity (POSSUM) scoring system 3004 patients were assessed. From the predictions of mortality and morbidity so obtained, a quality measure, the ratio of observed to expected numbers of deaths and complications (O:E ratio) was determined for each surgeon, both overall and within specialty zones. The present study demonstrates the serious hazard in using ‘raw’ uncorrected mortality and morbidity statistics to compare surgeon performance. Mortality rates varied from 1·0 to 4·9 per cent whereas O:E ratios ranged from 0·83 to 1·06; morbidity rates varied from 5·3 to 12·6 per cent with O:E ratios 0·86-1·02. Great misunderstanding may result from the publication of surgeon or hospital ‘league tables’. The present study demonstrates a technique that might allow surgeon performance to be monitored adequately and accurately.
Human intraperitoneal fibrinolytic response to elective surgery
Authors: Scott-Coombes D , Whawell S , Vipond M N , Thompson J 
Published: March 2007

Abstract
Intra-abdominal adhesions develop in over 90 per cent of patients undergoing laparotomy. Peritoneal fibrinolysis is believed to be important in the pathophysiology of adhesion formation. This study investigated the fibrinolytic response of postoperative peritoneal fluid in 12 patients undergoing elective laparotomy. There was a significant reduction in the plasminogen activating activity to undetectable levels at 24 h, which was sustained at 48 h (P &lt;0·05). While there was an early reduction in the concentration of tissue plasminogen activator (median 40·0, 28·2, 16·3 and 31·9 ng/ml at 2, 6, 24 and 48 h respectively, P &lt; 0·05), the abolition of functional fibrinolytic activity appeared to be secondary to a marked increase in the concentration of plasminogen activator inhibitor (PAI) 1 (median 86, 196, 800 and 730 ng/ml at 2, 6, 24 and 48 h respectively; P &lt; 0·05) and PAI-2 (median less than 6, 12, 155 and 245 ng/ml at 2, 6, 24 and 48 h respectively; P &lt; 0·05). This reduction in the plasminogen activating activity of peritoneal fluid may favour the formation of permanent fibrous adhesions following surgery.
Lactulose as an antiendotoxin in experimental colitis
Authors: Gardiner K R , Erwin P J , Anderson N H , McCaigue M D , Halliday M I , Rowlands B J 
Published: March 2007

Abstract
The efficacy of lactulose as an antiendotoxin was studied and the effect of lactulose or colistin on faecal flora was investigated in a hapten-induced rat model of colitis. Enteral administration of lactulose to rats with colitis was associated with a significant reduction in the systemic concentration of endotoxin (median (range) 5.4 (0–19.9) versus 23.7 (0–145.0) pg/ml in colitic rats treated with water; 4.6 (0–10.8) pg/ml in healthy animals). Enteral administration of colistin significantly reduced the faecal count of aerobic Gram-negative bacilli (median (range) 2.84 (1.40–8.43) versus 8.26 (4.50–10.40) log10 colony-forming units per g faeces after treatment with water) but not the faecal load of endotoxin. Patients with inflammatory bowel disease may benefit from enteral treatment with lactulose to prevent systemic endotoxaemia and/or with colistin to modify enteric bacteria.
Human immunodeficiency virus infection and genital warts as risk factors for anal intraepithelial neoplasia in homosexual men
Authors: Carter P S , de Ruiter A , Whatrup C , Katz D R , Ewings P , Mindel A , Northover J M A 
Published: March 2007

Abstract
The incidence of anal intraepithelial neoplasia (AIN) was studied in a group of 210 homosexual and bisexual men. The presence of genital warts and human immunodeficiency virus (HIV) infection was assessed as risk factors for the development of AIN. In all, 74 (35 per cent) of the group had histological evidence of AIN. The relative risk of being positive for HIV on AIN (relative to being negative for HIV) was 1.58 (95 per cent confidence interval (c.i.) 1.01–2.48). The relative risk of anal warts on AIN (relative to absence of anal warts) was 4.70 (95 per cent c.i. 1.81–12.20). Logistic regression analysis showed no significant interactive effect between HIV and anal warts on the risk of AIN. It is concluded from the results of a Mantel-Haenzel analysis that the presence of anal warts and HIV infection are independent risk factors for the development of AIN in homosexual and bisexual men.