bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer
Authors: Havenga K , De Ruiter M C , Enker W E , Welvaart K 
Published: March 2007

Abstract
Total mesorectal excision with autonomic nerve preservation for rectal cancer is based on the anatomy of the mesorectum and of the pelvic autonomic nerves. Cadaver dissections were performed to describe the relationship between these structures. Between the rectum and the sacrum a retrorectal space can be developed, lined anteriorly by the visceral leaf and posteriorly by the parietal leaf of the pelvic fascia. The hypogastric nerve runs anterior to the visceral fascia, from the sacral promontory in a laterocaudad direction. The splanchnic sacral nerves originate from the sacral foramina, posterior to the parietal fascia, and run caudad, laterally and anteriorly. After piercing the parietal layer of the pelvic fascia, approximately 4 cm from the midline, the sacral nerves run between a double layer of the visceral part of the pelvic fascia. The relationship between the hypogastric nerves, the splanchnic nerves and the pelvic fascia was comparable in all six specimens examined.
Diagnosis of arterial disease of the lower extremities with duplex ultrasonography
Authors: Koelemay M J W , den Hartog D , Prins M H , Kromhout J G , Legemate D A , Jacobs M J H M 
Published: March 2007

Abstract
The development of duplex scanning carries the prospect of an entire non-invasive work-up of patients with peripheral arterial occlusive disease. To obtain the best available estimates of its diagnostic accuracy, a meta-analysis of 71 studies evaluating duplex scanning was performed. Independent methodological judgement left 16 studies for data extraction. Pooled estimates 95 per cent confidence interval of sensitivity and specificity for detection of a stenosis greater than or equal to 50 per cent or occlusion in the aortoiliac tract were 86 (80–91) per cent and 97 (95–99) per cent respectively. The results for the femoropopliteal tract compared well with this, with a sensitivity of 80 (74–85) per cent and a specificity of 96 (94–98) per cent. The accuracy of detection of a stenosis greater than or equal to 50 per cent or an occlusion in the infragenicular arteries was lower with a sensitivity and specificity of 83 (59–96) per cent and 84 (69–93) per cent respectively. Duplex scanning is an accurate tool for assessment of atherosclerotic lesions in the aortoiliac and femoropopliteal tract and can replace routine pre-interventional angiography in a substantial number of patients.
Simple and reliable technique for local resection of early gastric cancer
Authors: Nihei Z , Ichikawa W , Osanai T , Togo S , Miyanaga T , Hayashi T , Hirayama R , Mishima Y 
Published: March 2007

Abstract
There has been an increase in the number of recognized early gastric cancers with the recent advance in diagnostic modalities1. In some cases, less aggressive procedures are indicated and local resection, with or without limited lymph node dissection, is one of the treatments of choice. It is, however, sometimes difficult to ensure adequate excision with tumour-free margins because such lesions are movable and may not be firmly fixed to the muscle layer. A simple technique to determine the sites to be incised to allow adequate resection of the tumorous lesion with ease and safety is reported here.
Postoperative thromboembolism after day-case herniorrhaphy
Authors: Riber C , Alstrup N , Nymann T , Bogstad J W , Wille-Jørgensen P , Tønnesen H 
Published: March 2007

Abstract
Thromboembolism is a serious complication oi surgery and prophylaxis is therefore recommended. This study examines a new aspect of the problem, the incidence of thromboembolism after day-case surgery. From 1982 to 1992, 2281 patients underwent day-case repair for inguinal hernia management. Hospital admission for thromboembolism within the first 30 days after surgery was identified by computer linkage to the National In-Patient Register, which contains details of all hospital admissions in Denmark. One patient developed non-fatal pulmonary embolism. No other patients were admitted to hospital with venous thromboembolism within 30 days of herniorrhaphy. It is concluded that there is no need for routine prophylaxis for thromboembolism in day-case hernia surgery.
Arterial therapy of hepatic colorectal metastases
Authors: Vauthey J-N , Marsh R De W , Cendan J C , Chu N-M , Copeland E M 
Published: March 2007

Abstract
Considerable experience of the treatment of irresectable hepatic colorectal metastases has accumulated over the past three decades. In this review, the rationale for hepatic artery treatment of colorectal metastases to the liver is presented and various access techniques and chemotherapeutic agents for infusion are discussed. Randomized trials of hepatic artery chemotherapy (HAC) are analysed, and the promising results of recent studies combining less toxic and more effective agents are summarized. Continuous infusion pumps provide the most reliable and long-lasting access for HAC. Appropriate surgical techniques and medical management can minimize complications. Although tumour progression is best controlled by HAC, a clear-cut survival advantage has yet to be demonstrated. While hepatic artery infusion chemotherapy cannot yet be recommended outside investigational protocols, the experience gained so far should stimulate further studies.
Liver metastases from colorectal cancer: Lessons from past and present clinical studies
Authors: Taylor I 
Published: March 2007

Abstract
In patients with primary colorectal cancer the development of liver metastases has traditionally been equated with imminent demise. This metastatic event is remarkably common; indeed, liver metastases are present in some 25 per cent of patients at the time of initial colorectal resection and over 50 per cent of patients will eventually develop them. Some 90 per cent of patients who die from colorectal cancer have liver metastases. There are few cancers in which the metastatic pattern has such a high degree of predictability. Information from past and present clinical studies should, therefore, provide a basis for logical approaches to prevention and treatment.
Effect of terminal ileal transposition on intestinal absorption following proctocolectomy
Authors: Hotokezaka M , Nakahara S , Iwamoto T , Chijiiwa K , Mibu R 
Published: March 2007

Abstract
A terminal ileal transposition procedure, in which a distal jejunal segment is interposed between the terminal ileum and the anus following proctocolectomy, is described. Adult mongrel dogs had either terminal ileal transposition (n = 5) or ileoanal anastomosis (n = 6) following two-stage proctocolectomy. Untreated dogs were used as controls (n = 7). Twelve weeks after the second-stage operation, a perfusion study was performed. After terminal ileal transposition the transposed terminal ileum showed a high absorptive capability for sodium, chloride and bile acids (P &lt; 0·05, P &lt; 0·05 and P &lt; 0·001 respectively). After ileoanal anastomosis the absorptive capability of the terminal ileum was not enhanced significantly. In the mid-jejunum, the absorption of bile acids, chloride and glucose was enhanced (all P &lt; 0·05) only after terminal ileal transposition. Terminal ileal transposition improves the absorptive capability of the terminal ileum and the mid-jejunum compared with conventional ileoanal anastomosis in this model.
Screening for colorectal cancer with an immunological faecal occult blood test: 2-Year follow-up
Authors: Robinson M H E , Marks C G , Farrands P A , Bostock K , Hardcastle J D 
Published: March 2007

Abstract
This study is a 2-year follow-up of an average-risk population Offered screening with both Haemoccult and Hemeselect tests to determine the interval cancer rate, and thus sensitivity. The effect on compliance with Hemeselect of testing over 1 day rather than 3 days was investigated in a separate cohort. In the first study, 3948 subjects received tests; 1489 (37·7 per cent) completed both tests and 148 had a positive result, 17 (1·1 per cent) were Haemoccult positive and 145 (9·7 per cent) were Hemeselect positive. Investigation of 142 patients revealed ten with cancer (Dukes stage A, seven; B, one; C, two). All were detected by Hemeselect but only one was Haemoccult positive. After a median follow-up of 35 (range 26–43) months, seven further patients developed colorectal cancer (stage A, one; B, three; C, three) but none followed a negative Hemeselect test (100 per cent sensitivity). In the second study 2703 subjects were offered Hemeselect tests. Compliance for testing over 1 day (48·6 per cent) was significantly better than that over 3 days (43·1 per cent) (χ2 = 8·1, 1 d.f., P &lt; ·01). Hemeselect is a promising screening test for the early detection of colorectal cancer.
Comparison of venous reflux in the affected and non-affected leg in patients with unilateral venous ulceration
Authors: Bradbury A W , Brittenden J , Allan P L , Ruckley C V 
Published: March 2007

Abstract
In 54 patients with unilateral leg ulceration of purely venous aetiology the only difference in venous reflux between affected and non-affected legs was with respect to the popliteal and crural veins. Deep and superficial venous reflux is common in legs without the skin changes typical of chronic venous insufficiency. The significance of venous reflux in an ulcerated leg cannot therefore be determined without reference to the contralateral, clinically normal, limb. Surgery should be directed at correcting reflux present in the ulcerated limb but not in the unaffected limb. In a minority of patients this entails superficial venous surgery alone, but in the majority such an approach would, ideally, entail correction of deep venous incompetence.
Surveillance imaging of the operated artery does not alter clinical outcome following carotid endarterectomy
Authors: Naylor A R , John T , Howlett J , Gillespie I , Allan P , Ruckley C V 
Published: March 2007

Abstract
Clinical outcome was studied in 243 patients undergoing 260 carotid endarterectomies; 166 of these patients underwent serial postoperative surveillance imaging. Including perioperative events, cumulative freedom from ipsilateral stroke was 86 and 82 per cent at 5 and 10 years respectively; the mean incidence of ipsilateral stroke was 1·8 per cent per annum. Twenty patients (8 per cent) suffered cerebral ischaemic events in the hemisphere of the operated side during follow-up: eight transient ischaemic attacks (TIA) and 12 strokes (only two preceded by TIA). Two symptomatic patients were found to have occluded the operated artery but the remainder had no evidence of significant recurrent disease. Cumulative freedom from occlusion or severe (greater than 70 per cent) recurrent stenosis was 87 and 78 per cent at 5 and 10 years respectively; the mean incidence of recurrence of significant disease was 2·2 per cent per annum. No revisional surgery was performed on the operated arteries. In its current format, neither clinical nor surveillance imaging could have prevented any of the strokes observed during follow-up.
Laparotomy for abdominal sepsis in the critically ill
Authors: Anderson I D , Fearon K C H , Grant I S 
Published: March 2007

Abstract
Among 125 patients admitted to an intensive care unit (ICU) with severe abdominal sepsis over a 3-year period, further laparotomy was required in 60 (48 per cent). The median age of these 60 patients was 67 (range 22–88) years and their admission APACHE (Acute Physiology and Chronic Health Evaluation) I1 score was 24 (range 7–40); 25 patients (42 per cent) survived to leave the ICU but only 19 (32 per cent) survived to leave hospital. These patients underwent 95 (median 1; range 1–6) operations after admission to the ICU and survival fell with increasing number of operations in the ICU (P = 0·01). A total of 81 operations (85 per cent) were therapeutic in that pus was drained or dead tissue removed, and 41 operations (43 per cent) resulted in improvement in the patient's condition within 48 h of surgery. Only nine per cent of patients not improved by their first operation in the ICU survived (P &lt; 0·0001). The source of sepsis was eradicated from the abdomen in 37 patients (62 per cent); this was a prerequisite for survival but was achieved less frequently with increasing number of operations (P &lt; 0·002). When operations were delayed until the diagnosis was clear, the need for subsequent procedures was significantly increased (P &lt; 0·05). Multiple operations for patients with abdominal sepsis in the ICU were associated with diminishing returns and alternative surgical strategies merit active consideration.
Laparoscopic mobilization of the stomach for oesophageal replacement
Authors: Jagot P , Sauvanet A , Berthoux L , Belghiti J 
Published: March 2007

Abstract
Nine patients of mean(s.d.) age 61(8) years underwent oesophagogastrectomy with laparoscopic gastric mobilization and abdominal lymphadenectomy for oesophageal cancer. Moderate to severe airway obstruction was present in all patients, in whom the mean(s.d.) value of forced expiratory flow rate at 1 s was 65(17) (range 35–85) per cent of the predicted value. Six patients had an abdominal laparoscopic approach combined with a right open thoracotomy; the other three had a laparoscopic abdominal and transhiatal approach combined with a left cervicotomy. No patient required conversion to open laparotomy. All had an uneventful postoperative course with extubation occurring at the end of the surgical procedure (n = 2) or on day 1 after operation (n = 7). Mean(s.d.) duration of hospitalization was 10·3(3·1) (range 8–18) days. The laparoscopic approach for gastric mobilization and abdominal lymphadenectomy is safe and can be used in patients with impaired pulmonary function.
Fc-receptor function after human splenic autotransplantation
Authors: Leemans R , Beekhuisi H , Timenss W , The T Hauw , Klasen H J 
Published: March 2007

Abstract
Mononuclear phagocytic function was studied using the Fc-receptor test in 24 patients who underwent splenectomy, ten of whom underwent splenic autotransplantation. All patients undergoing autotransplantation had mononuclear phagocyte system (MPS) activity at the transplantation sites. In eight of the 14 patients who did not undergo autotransplantation there was also scintigraphic MPS activity indicative of ectopic splenic tissue. Although the Fc-receptor test showed delayed and monoexponential blood clearance in all patients after splenectomy, there were no significant differences between the patient groups. Autotransplantation of small amounts of splenic tissue after splenectomy provides some MPS activity but is inadequate for blood clearance.
Laparoscopic surgery for duodenal ulcer: First results of a multicentre study applying a personal procedure
Authors: Gomez-Ferrer F , Balique J G , Azagra S , Bicha-Castelo H , Castro-Sousa F , Espalieuh P , Rodero D , Estour E 
Published: March 2007

Abstract
Between January 1991 and February 1995 data were gathered on 136 patients operated on in 14 surgical centres. All patients underwent posterior truncal vagotomy (PTV) and anterior linear gastrectomy (ALG) for chronic duodenal ulcer. Recurrence and repeated bleeding were the main indications for surgery. An antireflux technique was simultaneously carried out in 17 patients, while 13 underwent cholecystectomy. There were no peroperative complications or deaths, and the mean duration of operation was 65 (range 25–180) min. Immediate postoperative morbidity rate was 2·9 per cent, with a mean hospital stay of 3·1 (range 2–13) days. A total of 131 patients were evaluated between 6 and 33 (mean 25) months after operation. Of these, 126 (96·2 per cent) were graded as Visick I or II. Four (3·0 per cent) were Visick III, and one patient (0·8 per cent) was considered Visick IV. Gastric function studies were performed in 45 patients before and after operation, with a maximum acid output reduction of 83 per cent 3 months after the operation. Laparoscopic PTV with ALG constitutes a simple, efficient, rapid and safe method in the treatment of patients with chronic duodenal ulcer.
Synergistic antitumour effect of recombinant human tumour necrosis factor a with melphalan in isolated limb perfusion in the rat
Authors: Manusama E R , Nooijen P T G A , Stavast J , Durante N M C , Marquet R L , Eggermont A M M 
Published: March 2007

Abstract
The efficacy of isolated limb perfusion (ILP) for ‘intransit’ metastases from malignant melanoma and irresectable soft tissue sarcoma has been improved considerably by the addition of tumour necrosis factor (TNF) α. A rat sarcoma tumour model was, therefore, developed to evaluate the effects of TNF-α, melphalan and the combination of these drugs in the treatment of sarcoma. In BN rats bearing the non-immunogenic BN 175 sarcoma ILPs were performed with perfusate only, TNF-α, melphalan alone, or in combination when tumours had grown to approximately 1·5 cm in diameter. All rats treated with sham perfusion or perfusion with 50 μg TNF-α showed progressive disease. After perfusion with 40 μg melphalan no change in tumour diameter was observed in any rats at 4 days. After a combined perfusion with 40 μg melphalan and 50 μg TNF-α complete remission was noted in 12 of 16 rats. This synergistic effect in vivo between relatively ineffective doses of TNF-α and melphalan was not observed in vitro.
Nutritional pharmacology and malignant disease: A therapeutic modality in patients with cancer
Authors: Heys S D , Gough D B , Khan L , Ermin O 
Published: March 2007

Abstract
It is now established that certain nutrients have a significant effect on cellular metabolism and growth, tissue repair and regeneration, and modulation of host defences. So far, however, potential clinical benefits have been difficult to demonstrate. Nevertheless, the use of nutrients in combinations seems to have promise and may be associated with a reduction in infectious complications and length of hospital stay. Nutritional pharmacology in the future may be able to improve tumour response to chemotherapy and may minimize the metabolic effect of cachexia.
Assessment of splanchnic tissue oxygenation by gastric tonometry in patients undergoing laparoscopic and open cholecystectomy
Authors: Thaler W , Frey L , Marzoli G P , Messmer K 
Published: March 2007

Abstract
This experimental study compared the effects of laparoscopic (n = 31) and open (n = 32) cholecystectomy on gastric intramucosal pH (pHj). For this purpose, pHj was measured tonometrically before induction of anaesthesia, at 30-min intervals during surgery, and 1, 2 and 4 h after operation in otherwise healthy patients undergoing elective cholecystectomy. Additionally, perioperative arterial pH (pHa), arterial carbon dioxide tension (PaCO2), intramucosal carbon dioxide tension, arterial bicarbonate concentration, end-tidal carbon dioxide pressure (PECO2), levels of serum lactate, lactate dehydrogenase (LDH) and γ-glutamyl transferase (GGT), haematocrit and arterial blood pressure were recorded. In the two groups no significantly different changes occurred in pHi, pHa, serum lactate concentration or haematocrit at any of the observation times. PECO2 and PaCO2 were significantly raised during the laparoscopic procedure, whereas levels of LDH and GGT and arterial blood pressure rose during and after open cholecystectomy. In spite of the increased intra-abdominal pressure and the peritoneal carbon dioxide absorption related to the creation of a pneumoperitoneum, no decrease in pHi was detectable during laparoscopic cholecystectomy.
Survival after resection for ductal adenocarcinoma of the pancreas
Authors: Sperti C , Pasquali C , Piccoli A , Pedrazzoli S 
Published: March 2007

Abstract
A retrospective study was performed of 113 patients who underwent surgical resection of carcinoma of the pancreas from 1970 to 1992. The postoperative mortality rate was 15 per cent (5 per cent in the last 11 years). The actuarial 5-year survival rate was 12 per cent. Survival was significantly influenced by age (P = 0·03), vascular resection (P = 0·02), radicality of operation (P = 0·01), number of transfused blood units (P = 0·01), tumour differentiation (P = 0·002), lymph node status (P = 0·001), perineural invasion (P = 0·01), tumour size (P = 0·008), preoperative diabetes (P = 0·001) and stage (P = 0·0001). Multivariate analysis showed that stage, diabetes, age and grade were independent predictors of long-term survival. The type of pancreatic resection (Whipple, subtotal, total or distal pancreatectomy) did not influence prognosis. The 5-year survival rate was 14 per cent in the period 1970–1981 and 11 per cent in the period 1982–1992, with no statistical difference. These results suggest that patient characteristics and tumour findings rather than operative procedures affect long-term survival after resection for pancreatic carcinoma.
Donor arterial variations in liver transplantation: Management and outcome of 527 consecutive grafts
Authors: Soin A S , Friend P J , Rasmussen A , Saxena R , Tokat Y , Alexander G J M , Jamieson N V , Calne R Y 
Published: March 2007

Abstract
The impact of donor arterial variations and their management was investigated retrospectively in 527 consecutive allografts. Anomalous arteries were found in 161 grafts (30·6 per cent). There was no significant difference in the overall incidence of arterial complications between grafts with normal (3·6 per cent) and abnormal (5·6 per cent) anatomy. However, there was a higher incidence of arterial complications in transplants requiring multiple arterial anastomoses (P = 0·02), or anastomosis of donor vessels to recipient aorta with (P = 0·0003) or without (P = 0·04) an interposition graft for arterial reconstruction. The incidence of biliary complications was similar in grafts with a normal (18·8 per cent) or anomalous (18·0 per cent) arterial supply. Anomalies of hepatic arterial anatomy occur in one-third of all livers and do not compromise graft outcome unless multiple anastomoses or direct anastomosis to the recipient aorta are required for arterial reconstruction.
Antegrade colonic enemas
Authors: Dick A C , McCallion W A , Brown S , Boston V E 
Published: March 2007

Abstract
Thirteen children aged 6–14 (mean 8) years in whom an antegrade colonic enema procedure was performed were reviewed retrospectively. All presented with refractory constipation or faecal soiling over a 3-year period. Nine of the children had previously undergone pull-through procedures for Hirschsprung's disease or high anorectal malformations. Two were suffering from spina bifida and two from idiopathic functional constipation. The operation was performed through a right iliac fossa incision. A catheterizable conduit was created. The appendix was brought out to the wound edge and made continent by intussuscepting the appendix base into the caecum. When the appendix was absent or unusable, a caecal tube was formed. Five patients suffered minor morbidity, six required a further operative procedure and two eventually required a sigmoid colostomy. However, the eventual outcome of a continent stoma was attained in 11 of the 13 children, all of whom would have been considered for sigmoid colostomy before introduction of the antegrade colonic enema procedure.