bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental pancreatic cancer in the rat treated by photodynamic therapy
Authors: Evrard S , Keller P , Hajri A , Balboni G , Mendoza-Burgos L , Damgé C , Marescaux J , Aprahamian M 
Published: March 2007

Abstract
Selective histological necrosis of experimental pancreatic carcinoma by photodynamic therapy (PDT) has been successful with haematoporphyrin derivatives and phthalocyanine as photosensitizers. This report describes the feasibility of PDT with pheophorbide A as the photosensitizer to treat azaserine-induced pancreatic rat carcinoma and analyses survival of the animals. An organ distribution study 24h after pheophorbide A administration (9 mg/kg intravenously) gave a selectivity ratio of 13·5:1 between tumour and surrounding tissue. Light of 660 nm and 100 J/cm2 induced selective necrosis of the tumour. Six of nine rats were cured in 120 days whereas all 36 control animals died within 35 days (P &lt; 0·01). The pancreas and hepatic pedicle were relatively unaffected by PDT, but the duodenum was injured.
Preoperative endoscopic drainage for malignant obstructive jaundice
Authors: Lai E C S , Mok F P T , Fan S T , Lo C M , Chu K M , Liu C L , Wong J 
Published: March 2007

Abstract
The role of preoperative endoscopic drainage for patients with malignant obstructive jaundice was evaluated in a randomized controlled trial. A total of 87 patients were assigned to either early elective surgery (44 patients) or endoscopic biliary drainage followed by exploration (43). Thirty-seven patients underwent successful stent insertion and 25 had effective biliary drainage. Complications related to endoscopy occurred in 12 patients. After endoscopic drainage significant reductions of hyperbilirubinaemia, indocyanine green retention and serum albumin concentration were observed. Patients with hilar lesions had a significantly higher incidence of cholangitis and failed endoscopic drainage after stent placement. The overall morbidity rate (18 patients versus 16) and mortality rate (six patients in each group) were similar in the two treatment arms irrespective of the level of biliary obstruction. Despite the improvement of liver function, routine application of endoscopic drainage had no demonstrable benefit. Endoscopic drainage is indicated only when early surgery is not feasible, especially for patients with distal obstruction.
Modulation of immune function and weight loss by l-arginine in obstructive jaundice in the rat
Authors: Kennedy J A , Kirk S J , McCrory D C , Halliday M I , Barclay G R , Rowlands B J 
Published: March 2007

Abstract
Jaundiced surgical patients have a high incidence of postoperative complications. Many causative factors have been identified including cachexia and immune suppression. The amino acid L-arginine has anabolic and immunostimulatory properties. It was hypothesized that dietary supplementation with L-arginine would diminish the weight loss and immune suppression of obstructive jaundice. Sixteen male Wistar rats rendered jaundiced by bile duct ligation were allocated to two groups. The test group (n = 8) received drinking water supplemented with 1·8 per cent L-arginine ad libitum and the control group (n = 8) received a solution of isonitrogenous glycine. Both groups had free access to standard chow. Body-weight, and fluid and food intake were recorded. After 21 days, delayed-type hypersensitivity to 2,4-dinitrofluorobenzene was assessed. Animals receiving L-arginine consumed more food than controls (mean(s.e.m.) 414(16) versus 360(13) g, P &lt; 0·05) and lost less weight (mean(s.e.m.) proportion of initial body-weight lost 7·8(1·2) versus-14·8(1·4) per cent P &lt; 0·05). The delayed-type hypersensitivity response was significantly greater in rats receiving L-arginine (mean(s.e.m.) increase in ear thickness 23·9(2·7) versus 9·4(2·1) per cent, P &lt; 0·05). In this animal model of obstructive jaundice dietary supplementation with L-arginine diminished both weight loss and immune suppression.
Early laparoscopic biliary injury: Experience in New Zealand
Authors: Windsor J A , Vokes D E 
Published: March 2007

Abstract
Data on the incidence, nature and management of early laparoscopic biliary injury up to January 1993 were obtained by a postal questionnaire sent to all New Zealand general surgeons (n = 214; response rate 71 per cent) and to all endoscopists who perform endoscopic retrograde cholangiography (n = 16; response rate 100 per cent). A total of 41 injuries (surgeons' survey, 22; endoscopists' survey, 19) occurred in an estimated 4000 laparoscopic cholecystectomies; 16 involved the common bile and hepatic ducts, and 25 the cystic and segment V ducts. Operative cholangiography was performed in one patient. The diagnosis of injury was made after operation in 31 of 41 patients and after discharge in 21. Conservative management was undertaken in only 19 patients. This prospective audit documents an increase in the incidence of early biliary injury after the introduction of laparoscopic cholecystectomy in New Zealand. The results highlight the need for further study to determine the best way to ensure early and accurate diagnosis of biliary injury and to define optimal conservative and operative management.
Irritable bowel syndrome in patients discharged from surgical wards with non-specific abdominal pain
Authors: Doshi M , Heaton K W 
Published: March 2007

Abstract
A questionnaire was used to discover the prevalence of seven recognized symptoms of irritable bowel syndrome (IBS) in 96 patients who had been discharged from hospital 1–2 years previously with the diagnosis of non-specific abdominal pain. Compared with 1897 controls from a population survey in the same city, the patients were more likely to have these symptoms; the differences were statistically significant in most cases. The frequency of recurrent abdominal pain with features suggesting an intestinal origin was increased fivefold in male and fourfold in female patients (P &lt; 0·001). Criteria for the diagnosis of IBS were present in 37 per cent of women and 19 per cent of men, versus 5 and 2 per cent respectively in controls (P &lt; 0·001). Approximately half the patients remembered having symptoms of IBS at the time of admission and 70 per cent had had other attacks of abdominal pain. At the time of admission, the hospital notes mentioned the possibility of IBS in only 6 per cent of cases. Most patients would have welcomed an explanation for the pain at the time of their hospital admission.
Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum
Authors: Karanjia N D , Corder A P , Bearn P , Heald R J 
Published: March 2007

Abstract
Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11·0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6·4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6cm (P = 0·08). The abdominoperineal excision rate was 9·1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0·03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0·002), and three died (P = 0·02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0·05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors incude: a clean dry pelvie cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.
Anterior anal sphincter repair in patients with obstetric trauma
Authors: Engel A F , Kamm M A , Sultan A H , Bartram C I , Nicholls R J 
Published: March 2007

Abstract
Anterior sphincter repair for faecal incontinence related to obstetric trauma was performed in 55 patients: 32 with incontinence after delivery and 23 with late onset. Anal endosonography and physiological tests were performed before and after surgery. After a median of 15 (range 6–36) months, 42 patients had improved, 11 had not improved and two were awaiting colostomy closure. The postoperative squeeze pressure was increased (by 20 versus 5 cmH2O, P = 0·05) and the external sphincter was more frequently intact (32 of 35 versus five of 11, P = 0·003) in those with a good outcome. Patients with an intact external sphincter had higher postoperative squeeze pressures (50 versus 20 cmH2O, P = 0·004). Patients with late-onset incontinence were older than those who developed incontinence soon after delivery (median 59 versus 32 years, P &lt; 0·001) and had longer pudendal nerve terminal motor latencies (2·3 versus 2·2 ms, P = 0·03). Failure of repair is related to persistent external sphincter defects. Late-onset incontinence, even with a prolonged pudendal nerve terminal motor latency, does not preclude a good outcome.
Pathobiology of intimal hyperplasia
Authors: Davies M G , Hagen P-O 
Published: March 2007

Abstract
In the current vascular interventional environment, high restenosis rates have increased awareness of the significance of intimal hyperplasia, a chronic structural lesion that develops after vessel wall injury, and which can lead to luminal stenosis and occlusion. Intimal hyperplasia may be defined as the abnormal migration and proliferation of vascular smooth muscle cells with associated deposition of extracellular connective tissue matrix. The pathology of intimal hyperplasia is reviewed with particular attention to its physiology, pharmacology, cell biology and molecular biology.
Radiotherapy and the management of the axilla in early breast cancer
Authors: Falk S J 
Published: March 2007

Abstract
The role of radiotherapy in the management of the axilla in early breast cancer is examined. A few, carefully selected, clinically node-negative postmenopausal women may require no intervention to the axilla. Otherwise, surgical clearance is the preferred sole management of the axilla, resulting in an excellent level of local control and providing optimal information for the use of systemic adjuvant therapy. Axillary radiotherapy can also provide equivalent levels of long-term control in the clinically node-negative axilla, but the chronic disabling syndrome of brachial plexopathy is documented at all radiation doses that can sterilize microscopic disease, irrespective of the radiotherapy technique. A combination of radiotherapy and axillary surgery results in an increased morbidity rate compared with either alone. Women who receive radiotherapy to the breast alone are not at risk of brachial plexopathy.
Percutaneous transluminal angioplasty of the tibial arteries
Authors: Sivananthan U M , Browne T F , Thorley P J , Rees M R 
Published: March 2007

Abstract
To evaluate the results of percutaneous transluminal angioplasty (PTA) of the tibial vessels, results of 50 procedures performed in 38 patients since 1988 were analysed retrospectively. A total of 73 tibial vessels were treated: 32 anterior tibial arteries, 16 posterior tibial arteries, four peroneal arteries, 12 tibioperoneal trunks and nine trifurcation lesions. Forty-four of 50 PTA procedures were performed in conjunction with interventions in the femoropopliteal arteries and six as isolated procedures. One patient required a femorodistal graft following perforation of the popliteal artery during atherectomy. Distal emboli occurred in two patients and acute thrombosis of both the angioplastied tibial vessels occurred in a third. The technical success rate was 96 per cent. Patients were followed for a mean(s.d.) of 21(13) months. At the latest follow-up, 58 per cent had improved clinically. There were significant improvements in 43 per cent of limb isotope blood flow studies and 52 per cent of ankle : brachial Doppler pressure indices in treated limbs at this time. PTA should be the first treatment option in patients with infrapopliteal arterial disease needing intervention, whenever it is technically feasible.
Light-reflective cerebral oximetry and jugular bulb venous oxygen saturation during carotid endarterectomy
Authors: Williams I M , Picton A , Farrell A , Mead G E , Mortimer A J , McCollum C N 
Published: March 2007

Abstract
A novel instrument using reflected near-infra-red light spectroscopy to measure cerebral oxygen saturation non-invasively was evaluated during carotid endarterectomy; cerebral perfusion was compared with jugular bulb venous oxygen saturation and transcranial Doppler ultrasonographic measurements. Initially, oximetry sensors with light source-detector separation distances of 10 and 27 mm were positioned over the frontal area, while a cannula positioned in the jugular bulb permitted sampling for jugular bulb venous oxygen saturation. To increase cerebral oxygen saturation sensitivity, modified sensors with light source-detector separation distances of 30 and 40 mm were relocated over the middle cerebral artery territory. The changes in cerebral and jugular bulb venous oxygen saturation, and in peak blood flow velocity before and 30 s after carotid clamping and declamping were recorded. The modified cerebral perfusion system achieved improved correlations between cerebral and jugular bulb venous oxygen saturation changes during carotid clamping and declamping (r = 0·92, P&lt;0·001). The correlation between change in cerebral oxygen saturation and the percentage change in peak flow velocity on both cross-clamping and declamping was equally strong (r=0·90, P&lt; 0·001). Near-infra-red cerebral spectroscopy reliably detects changes in cerebral oxygen saturation during carotid endarterectomy and may have wide applications in monitoring brain perfusion during neurosurgery and cardiopulmonary bypass surgery, and in closed head injury.
Serum lipofuscin as a prognostic indicator of adult respiratory distress syndrome and multiple organ failure
Authors: Roumen R M H , Hendriks Th , de Man B M , Goris R J A 
Published: March 2007

Abstract
Toxic oxygen free radical damage is thought to play an important role in events such as trauma and sepsis, in which adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF) are the major causes of late death. Serum lipofuscin concentration has been proposed as an indicator of lipid peroxidation caused by toxic oxygen free radicals. Serum lipofuscin level was measured in 75 healthy controls and sequentially in 66 patients in the intensive care unit; the latter included 18 patients who had undergone elective major vascular surgery, 20 after repair of ruptured abdominal aortic aneurysm and 28 with severe blunt trauma. Fifteen of the 66 patients died within 2 days. Ten of the remaining 51 patients developed ARDS and/or MOF and 41 had an uncomplicated postoperative course. Serum lipofuscin concentration in controls showed a positive correlation with age. Compared with controls, all three patient groups had significantly increased lipofuscin concentrations during the first day after major vascular surgery, trauma or shock. In addition, the ten patients who subsequently developed ARDS and/or MOF showed significantly increased lipofuscin levels on day 1, compared with those in the 41 who had an uncomplicated clinical course. The concentration of serum lipofuscin, which may act as a simple and valuable measure of grading oxidative stress, is positively related to the incidence of subsequent ARDS and/or MOF in patients at risk of these syndromes.
Interleukin 6 is a prognostic indicator of outcome in severe intra-abdominal sepsis
Authors: Patel R T , Deen K I , Youngs D , Warwick J , Keighley M R B 
Published: March 2007

Abstract
Levels of plasma cytokines and circulating endotoxin were assessed in 41 patients with severe intra-abdominal sepsis. Comparison was made with the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system. Blood samples were taken within 24 h of onset of the sepsis syndrome and at serial times thereafter. Increased levels of interleukin (IL) 6 (range 50–25 500 pg/ml) were detectable in all patients with sepsis. Eighteen of the 19 deaths were attributable to sepsis and higher levels of IL-6 at the onset of the sepsis syndrome correlated with a poor outcome. The sensitivity of IL-6 concentration in predicting mortality was 86·4 per cent with a specificity of 78·9 per cent and an overall correct classification rate of 82·9 per cent. IL-6 level was a better predictor than APACHE II score (sensitivity 72·7 per cent, specificity 57·9 per cent, correct classification rate 65·9 per cent). Levels of tumour necrosis factor α, IL-1β and endotoxin did not correlate with mortality rate. Plasma IL-6 concentrations may help in planning future strategies to decrease the mortality rate associated with sepsis.
Role of fine-needle aspiration cytology and needle-core biopsy in the diagnosis of lobular carcinoma of the breast
Authors: Sadler G P , McGee S , Dallimore N S , Monypenny I J , Douglas-Jones A G , Lyons K , Horgan K 
Published: March 2007

Abstract
Fine-needle aspiration cytology (FNAC) plays a key role in the preoperative diagnosis of carcinoma of the breast but is less reliable in the diagnosis of infiltrating lobular carcinoma. The method of diagnosis was reviewed in 56 patients with lobular carcinoma who had attended screening and symptomatic clinics. In 29 patients FNAC results demonstrated malignant cells; 15 of these had palpable disease and the mean tumour size was 21 mm. In 27 patients FNAC failed to demonstrate malignant cells; 13 lesions were palpable and the mean tumour size was 23 mm. Ten patients were diagnosed by needle-core biopsy when FNAC was not diagnostic. FNAC may fail to diagnose even large lobular carcinoma and needle-core biopsy is strongly recommended in this situation.
Recurrence pattern of oesophageal carcinoma after limited resection does not support wide local excision with extensive lymph node dissection
Authors: van Lanschot J J B , Tilanus H W , Voormolen M H J , van Deelen R A J 
Published: March 2007

Abstract
The recurrence pattern after ‘limited’ resection for oesophageal carcinoma was analysed to determine whether more extensive local excision of tumour in combination with radical lymphadenectomy improves locoregional disease control and long-term survival. A total of 143 patients who underwent limited surgery with curative intent between 1983 and 1989 were studied: 90 with squamous cell carcinoma (group 1) and 53 with adenocarcinoma (group 2) of the thoracic oesophagus. One patient was lost to follow-up. Tumour recurrence occurred in 40 patients (44 per cent) in group 1 and 35 (66 per cent) in group 2. Locoregional recurrence in isolation occurred in 11 per cent of patients in group 1 and 8 per cent of those in group 2; locoregional recurrence was detected in combination with tumour elsewhere in 19 and 28 per cent respectively. In conclusion, one-third of patients at the most might potentially have benefited from more radical local tumour resection. Theoretical advantages such as a prolonged disease-free interval and definite cure should be weighed against the higher risk of serious complications. More extensive procedures should therefore be performed only in controlled clinical studies.
Emergency transjugular intrahepatic portasystemic stent shunting as salvage treatment for uncontrolled variceal bleeding
Authors: McCormick P A , Dick R , Panagou E B , Chin J K T , Greenslade L , McIntyre N , Burroughs A K 
Published: March 2007

Abstract
Creation of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was used as a rescue treatment for patients with variceal bleeding refractory to standard medical and endoscopic treatment. Over a 2-year period 242 episodes of variceal bleeding were treated and emergency shunting was performed on 20 patients with uncontrolled bleeding (Pugh grade A, one; B, seven; C, 12). The procedure was technically successful and controlled bleeding in all patients. Six patients had early rebleeding within 5 days, and further shunting was required in two. Two had late rebleeding related to shunt occlusion and had a further TIPSS procedure followed by portacaval shunting. Twelve patients died within 40 days from liver failure and sepsis, and there were two late deaths after 2 and 6 months, unrelated to bleeding. TIPSS insertion is an effective therapeutic option in patients with acute variceal bleeding refractory to medical and endoscopic treatment. However, despite control of bleeding in this group, the hospital mortality rate was high, reflecting the severity of the underlying liver disease.
Patterns of portal vein occlusion and their aetiological significance
Authors: Stringer M D , Heaton N D , Karani J , Olliff S , Howard E R 
Published: March 2007

Abstract
Clinical and angiographic findings in 53 patients with portal vein occlusion were reviewed to determine the relationship between the pattern of venous occlusion and its aetiology. Five major patterns were identified. Group 1 comprised three children with idiopathic intrahepatic portal vein occlusion alone (hepatoportal sclerosis). Those in group 2 (25 patients), with occlusion of the main portal vein, accounted for almost half the total number and for most of those with a probable congenital aetiology. The ten patients in group 3 had angiographic occlusion and collateralization of the main portal and superior mesenteric veins. Intra-abdominal sepsis, other than that from pancreatic disease, was associated with this pattern of venous occlusion in which the splenic vein is spared. No patients with isolated portal and splenic vein occlusion (group 4) were recorded. Widespread thrombosis throughout the portal venous system (group 5; 15 patients) had a multifactorial aetiology but was typically observed in hypercoagulable states that were also associated with hepatic vein occlusion or other deep vein thromboses.
Treatment of patients with irresectable liver metastases from colorectal cancer by chemo-occlusion with degradable starch microspheres
Authors: Civalleri D , Pector J-C , Håkansson L , Arnaud J-P , Duez N , Buyse M 
Published: March 2007

Abstract
Chemo-occlusion of the liver increases the tumour concentration of drugs. Thirty-nine patients with colorectal liver metastases received a monthly bolus administration of mitomycin C (10 mg/m2 on day 1) plus a continuous infusion of 5-fluorouracil (500 mg/m2 daily from days 1 to 5). Drugs were given via both portal (one-third of the dose) and arterial (two-thirds) routes to control large and small metastases. Arterially administered mitomycin C was mixed with individualized doses of degradable starch microspheres. In 16 patients treatment was not started or was interrupted early because of arterial or portal catheter problems. In 23 patients who received two or more cycles of treatment the mean (s.d.) microsphere dose was 835(399) mg. Toxicity was mild, consisting mainly of pain. Five complete and five partial responses were seen, and six patients had stable disease. The median time to progression and length of survival were 6 and 16 months respectively. The relatively high rates of complete and overall response in hypovascular tumours (six of 12 lesions) may support the rationale of chemo-occlusion.