bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of intraoperative ultrasonography on treatment strategy for colorectal cancer
Authors: Paul M A , Mulder L Sibinga , Cuesta M A , Sikkenk A C , Lyesen G K S , Meijer S 
Published: March 2007

Abstract
The impact of intraoperative ultrasonography (IOUS) on treatment strategy was studied in 122 patients with primary colorectal cancer. All patients underwent preoperative liver imaging by ultrasonography and computed tomography (CT). After curative resection of the primary tumour patients were eligible for adjuvant chemotherapy. The findings on IOUS were assessed by ultrasonography 6 months after laparotomy. Of 34 patients with suspected liver metastases on ultrasonography or CT, the diagnosis was confirmed by IOUS in 21. In the remaining 13 patients the suspect lesions were shown to be benign. Of the 88 patients with normal preoperative imaging results, suspect lesions were detected in five; in four the lesion was found by IOUS only. One of these four also had an extrahepatic metastasis. At follow-up the diagnosis of metastasis proved to be wrong in two of the remaining three patients, so IOUS was helpful in only one patient. Surgical management was not markedly influenced by findings on IOUS in any patient. However, IOUS correctly changed the stage of the disease, and consequently postoperative treatment, in 14 patients (11 per cent). Two patients were erroneously excluded from the adjuvant protocol following an incorrect diagnosis based on IOUS.
Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer
Authors: Beets G , Penninckx F , Schiepers C , Filez L , Mortelmans L , Kerremans R , Aerts R , De Rao M 
Published: March 2007

Abstract
To assess the clinical value of whole-body positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) in recurrent colorectal cancer, 35 patients were studied: 15 had resectable liver metastases, one a resectable lung metastasis, eight resectable pelvic recurrence, eight a presacral mass with equivocal findings on imaging, and three increasing serum levels of carcinoembryonic antigen (CEA) without clinical or radiological signs of recurrent disease. PET affected management decisions in seven of 16 patients with metastatic disease. In one of eight patients with pelvic recurrence demonstrated by computed tomography (CT), PET detected unknown pulmonary metastases. In five of eight presacral masses with equivocal CT findings, PET was correct and unexpected distant metastases were detected in one of these patients. In two of three patients with increasing CEA levels and normal pelvic CT findings, pelvic recurrence was identified. Overall, whole-body PET affected management in 14 patients. PET is a valuable tool for staging local recurrence and metastatic disease.
Motor abnormalities in the terminal ileum of patients with chronic idiopathic constipation
Authors: Panagamuwa B , Kumar D , Ortiz J , Keighley M R B 
Published: March 2007

Abstract
Abnormalities in oesophageal, gastric and jejunal motility have been described in patients with chronic idiopathic constipation, suggesting that this may be a panenteric disorder. To test the hypothesis that ileal motility is also abnormal in constipation, terminal ileal motility was studied in ten patients and six healthy controls by prolonged and ambulant manometry. Mean(s.e.m.) phase II activity was significantly prolonged in patients compared with controls, during wakefulness (61·6(7·3) versus 19·3(3·5) per cent, P&lt;0·001) and sleep (44·4(9·0) versus 1·1(0·8) per cent, P&lt;0·001). The mean(s.e.m.) duration of phase III fronts was shorter in patients (7·9(1·8) min) than in controls (13·2(1·3) min; P&lt;0·001). Retrograde propagation was seen in approximately 15 per cent of all phase IIIs in patients but not in control subjects. The mean(s.e.m.) duration of postprandial activity was significantly shorter in patients than in controls (30·1(6·2) versus 130·0(68·0) min, P&lt;0·001). Ileal motility is abnormal in patients with chronic idiopathic constipation. This may result from an abnormality of the enteric nervous system or abnormal modulation of this system by the central nervous system.
Effect of age, sex and parity on anorectal function
Authors: Jameson J S , Chia Y W , Kamm M A , Speakman C T M , Chye Y H , Henry M M 
Published: March 2007

Abstract
Ninety-one healthy subjects (51 women; age range 16–85 years) were studied prospectively to determine the effect of age, sex and parity on anorectal function. Maximum resting pressure, voluntary contraction pressure, rectal sensation to distension, rectal and mid-anal electrosensitivity, perineal descent, pudendal nerve terminal motor latency and fibre density of the external anal sphincter were measured. Sex influenced mean(s.d.) voluntary contraction pressure (148(56) versus 95(43) cmH2O for men versus women, P&lt;0·0001), perineal descent on straining (1·0(0·5) versus 1·3(0·4) cm, P=0·02) and fibre density (1·43(0·14) versus 1·52(0·15), P=0·02). Age influenced resting pressure (r= −0·43, P= 0·0001), perineal position at rest (r= −0·55, P&lt;0·0001), mid-anal electrosensitivity (r=0·42, P=0·0001) and rectal electrosensitivity (r=0·54, P&lt;0·0001). Parity affected mean(s.d.) voluntary contraction pressure (105(53) versus 75(20) cmH2O for nulliparous versus parous women, P=0·04) and mid-anal electrosensitivity (5·3(2·3) versus 4·5(2·3) mA, P=0·02). Increasing age leads to perineal descent at rest, slowed pudendal nerve conduction, a fall in resting anal pressure and decreased anorectal sensory function. Women have a lower anal squeeze pressure, greater perineal descent, longer pudendal nerve terminal motor latency and a greater muscle fibre density than men. Parity leads only to lower squeeze pressure.
Systemic responses in patients with intermittent claudication after treadmill exercise
Authors: Edwards A T , Blann A D , Suarez -Mendez V J , Lardi A M , McCollum C N 
Published: March 2007

Abstract
The effect of 5 min treadmill exercise was investigated in claudicant patients and healthy controls; systemic neutrophil count, plasma thromboxane and von Willebrand's factor (a marker for endothelial injury) were measured. Median (interquartile range (i.q.r.)) resting neutrophil count was 5.6 (5.2–6.0) × 106 cells 1−1 in claudicants and 2.8 (2.6–3.2) × 106 1−1 in controls (P &lt; 0.05); this increased in those with claudication to 7.1 (6.2–7.7) × 106 1−1 immediately after exercise (P &lt; 0.05). The resting plasma thromboxane level was 32.1 (25.0–60.0) pg m1 −1 in claudicants and rose to 135.0 (104.0–141.3) pg ml−1 15 min after exercise, compared with a rise from 25.0 (22.0–33.5) to 55.5 (33.0–67.0) pg ml−1 in controls (P &lt; 0.05). The resting serum von Willebrand's factor level was 127 (110–135) units dl−1 in claudicants compared with 60 (48–71) units dl−1 in controls; this difference persisted after exercise (P &lt; 0.01). In patients with claudication, the level of von Willebrand's factor increased to 150 (140–156) units dl−1 60 min after exercise (P &lt; 0.05). Free radical scavenging capacity was also investigated by measuring the plasma antioxidant activity of glutathione peroxidase and its essential non-metal co-factor selenium. Scavenging capacity was lower in claudicant patients whose median (i.q.r.) glutathione peroxidase activity (change in absorbance per min per ml plasma) was 2.84 (2.39–3.61) versus 3.24 (3.06–3.79) in controls (P &lt; 0.05). Similarly, plasma concentrations of selenium were lower in claudicants at a median (i.q.r.) of 75.0 (58.0–81.0) μg 1−1 compared with 88.0 (75.0–92.5) μg 1−1 in controls (P &lt; .05). Exercise in claudicant patients leads to neutrophilia and thromboxane production with subsequent endothelial injury. The antioxidant activity of glutathione peroxidase is reduced in patients with claudication and may allow the unopposed action of free radicals to damage endothelium.
Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery
Authors: Drummond M , Aristides M , Davies L , Forbes C 
Published: March 2007

Abstract
Deep vein thrombosis (DVT) is a common complication in patients undergoing elective hip surgery. Because of the associated risk of pulmonary embolism, prophylaxis with standard (unfractionated) heparin is becoming increasingly important. Recent clinical trials have shown a low molecular weight form of heparin, enoxaparin, to be more effective than standard heparin in preventing DVT, but the new drug is also more expensive. Data on clinical effectiveness and cost were combined in an economic evaluation of the two regimens. It was found that prophylaxis with enoxaparin would be expected to lead to a net saving of £20 per patient. The economic results are sensitive to the costs of enoxaparin, the costs of drug administration and the probability of false clinical diagnosis of DVT or pulmonary embolism.
Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy
Authors: Nies C , Sitter H , Zielke A , Bandorski T , Menze J , Ehlenz K , Rothmund M 
Published: March 2007

Abstract
A randomized controlled trial was performed to compare two techniques of bilateral subtotal thyroidectomy for non-toxic nodular goitre with regard to postoperative parathyroid function. The 50 patients in group 1 underwent ligation of the trunks of the inferior thyroid arteries. In group 2 (50 patients) the branches of these arteries were suture-ligated at the thyroid capsule. Total calcium, ionized calcium and parathyroid hormone levels were determined before operation, and 6, 24 and 72 h after surgery. Ninety-one patients were seen at follow-up 5–10 months after operation. Ten patients in group 1 and 12 in group 2 required calcium and/or vitamin D supplementation for symptomatic hypocalcaemia in the immediate postoperative period. At follow-up only one patient in each group had mild hypoparathyroidism. No statistically significant differences were found between groups regarding total calcium, ionized calcium and parathyroid hormone levels. Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy does not cause hypoparathyroidism or hypocalcaemia.
Early results of laparoscopic intraperitoneal onlay mesh repair for inguinal hernia
Authors: Chan A C W , Lee T W , Ng K W , Chung S C S , Li A K C 
Published: March 2007

Abstract
Over a 15-month period, 39 patients (37 men) of mean age 52 yean underwent laparoscopic inguinal hernia repair. Seven patients had bilateral hernia. Forty-six hernias (33 indirect, five direct, eight both direct and indirect) were repaired. A piece of polypropylene mesh measuring 8 × 10 cm was used to cover the direct and indirect spaces with an endoscopic multifeed hernia stapler. The mean operating time for unilateral and bilateral repair was 49 and 63 min respectively (range 25–90 min). One-third of patients required no postoperative analgesia and only seven had more than one injection of pethidine. The median postoperative stay was 7 (range 4–3) days. The mean period to resumption of daily activities was 7 (range 4–21) days. Three patients complained of paraesthesia of the lateral aspect of the thigh and one developed a hydrocele. Two recurrences were noted on follow-up at 3 months.
Combination chemotherapy with epirubicin, cisplatin and 5-fluorouracil for the palliation of advanced gastric and oesophageal adenocarcinoma
Authors: Highley M S , Parnis F X , Trotter G A , Houston S J , Penson R T , Harper P G , Mason R C 
Published: March 2007

Abstract
The palliative efficacy of laser therapy with combination chemotherapy (cisplatin, epirubicin and continuous infusion of 5-fluorouracil) was assessed in 34 patients with inoperable gastro-oesophageal cancer. Comparison was made with a group of 30 patients treated previously by laser alone. Twenty patients responded to chemotherapy. There was a significant improvement in dysphagia, as measured by a decreased laser requirement to maintain satisfactory swallowing. In this non-randomized prospective phase II trial, palliation was attained and some responses were long-lasting (median duration of response 8.7 (range 2.3 to more than 29.2) months).
Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy
Authors: Van Der Veen H , Hoekstra O S , Paul M A , Cuesta M A , Meijer S 
Published: March 2007

Abstract
A novel approach is described by which to identify the sentinel lymph node in patients with stage I melanoma. The technique involves a combination of intradermal patent blue V injection and γ probe-assisted surgery. Eleven patients with previously resected cutaneous melanoma, clinical stage I (Breslow thickness 1.35–3.20 mm), underwent sentinel node biopsy. Before surgery lymphoscintigraphy was performed to evaluate the pathways of lymphatic drainage from the site of the previously resected melanoma. A handheld γ probe was used to localize the sentinel node and to define the exact site of incision. At the same time, patent blue V (0.1–0.2 ml) was injected intracutaneously on either side of the scar to visualize the afferent lymphatic ducts and lymph nodes. By combining the use of the γ probe and vital dye staining, the sentinel node could easily be localized and identified in all 11 patients. After removal of the sentinel node(s) no residual radioactivity could be traced. In four patients with micrometastases in the sentinel node standard lymph node dissection was performed, including excision of the biopsy site; in only one lymphadenectomy specimen were micrometastases found in two other lymph nodes.
Enhanced Kupffer cell activity after repeated hepatic arterial ischaemia in an experimental model
Authors: Wang L -Q , Ding J -W , Persson B G , Bengmark S 
Published: March 2007

Abstract
Kupffer cells are important for host defence against both foreign invaders and neoplasia. Several studies have demonstrated that ischaemia and reperfusion activates Kupffer cells. The effect of hepatic arterial ischaemia on Kupffer cell function was assessed using blood clearance and organ uptake of radiolabelled Escherichia coli. Transient ischaemia for 1 h did not alter Kupffer cell function in comparison with sham operation. However, prolonging arterial ischaemia for 2 h stimulated Kupffer cell function; both the phagocytic index and liver uptake of radiolabelled E. coli increased significantly (P &lt; 0.01). Furthermore, this enhanced Kupffer cell activity was achieved each time the ischaemia was induced over a period of 5 days compared with repeated sham procedures (P &lt; 0.05). Serum tumour necrosis factor (TNF) was significantly released after both single and repeated arterial occlusion for 2 h (P &lt; 0.01). These observations show that transient arterial ischaemia enhances Kupffer cell function and induces TNF production.
Effect of platelet-activating factor on cold-preserved liver grafts
Authors: Hashikura Y , Kawasaki S , Matsunami H , Ikegami T , Nakazawa Y , Makuuchi M 
Published: March 2007

Abstract
Platelet-activating factor (PAF) may play an important role in graft injury in liver transplantation. Livers excised from male Wistar rats were preserved in University of Wisconsin solution for 6 h and then perfused with Krebs-Henseleit solution containing vehicle (bovine serum albumin) or PAF. Impairment of parenchymal cells was assessed by reference to tissue adenosine triphosphate levels, oxygen consumption and alanine aminotransferase activity in the effluent. The effect on non-parenchymal cells was evaluated by measurement of purine nucleoside phosphorylase and alanine aminotransferase levels in the effluent. Administration of as little as 1.0 ng kg−1 PAF caused a significant decrease in adenosine 5′-triphosphate concentration and oxygen consumption (P &lt; 0.5), although non-parenchymal cell injury was not affected. PAF can therefore cause liver graft dysfunction with hepatocytes as the main target, even in the absence of microcirculatory disturbance secondary to interaction between blood cells and endothelial cells.
Amelioration of experimental acute pancreatitis with a potent platelet-activating factor antagonist
Authors: Formela L J , Wood L M , Whittaker M , Kingsnorth A N 
Published: March 2007

Abstract
The effect of a potent platelet-activating factor (PAF) antagonist, BB-882, on an experimental model of acute pancreatitis induced in male Wistar rats by a technique of microvascular ischaemia was studied. A single intraperitoneal injection of BB-882 (5 mg/kg) 30 min after induction of the disease in 12 animals significantly reduced (P &lt; 0.001) the rise in the level of serum amylase (mean 2477 (range 2100–3280) units/1) compared with that in 12 control animals (mean 3928 (range 2800–5900) units/1) and significantly improved (P &lt; 0.001) the mean pancreatic histology score (5.0. (range 3–10) versus 12.3 (range 8–18) in controls). PAF is a biologically active ether phosphorylcholine synthesized in cell membranes and a potent inflammatory mediator. Pancreatic tissue levels of this compound are increased in experimental acute pancreatitis and pretreatment with PAF receptor antagonists can ameliorate the progression of this disease. BB–882 alters the early course of experimental pancreatitis and may have a clinical therapeutic role.
Risk factors for bile duct injury in laparoscopic cholecystectomy: Analysis of 49 cases
Authors: Schol F P G , Go P M N Y H , Gouma D J 
Published: March 2007

Abstract
Forty-nine bile duct injuries, representing 0.8 per cent of 6076 laparoscopic cholecystectomies performed in the Netherlands in 1990–1992, were reviewed. The aim of the study was to classify the injuries according to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity of the injury. On the basis of operative findings, bile duct injuries were classified from minor (classes I-IIIa) to extensive with loss of bile duct tissue (IIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa, 18 in class IIIb and four in class IV. In 16 patients the injury was detected during laparoscopic cholecystectomy and the procedure converted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of these 16 patients. In 20 of the 33 patients in whom identification of the injury was delayed to a second or third operation, more severe types of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P=0.002). Of eight patients with histologically proven acute cholecystitis at cholecystectomy, seven suffered severe injury (class IIIb or IV). Surgical experience with laparoscopic cholecystectomy was an important factor in the incidence of bile duct injury.
Persistence of idiopathic anal fistula may be related to epithelialization
Authors: Lunniss P J , Sheffield J P , Talbot I C , Thomson J P S , Phillips R K S 
Published: March 2007

Abstract
Anal fistulas may fail to heal because of continuing disease within the intersphincteric anal glands. Histological studies of the intersphincteric component of 18 consecutive idiopathic anal fistulas show that fistula persistence may be caused by epithelialization of the fistula track from internal or external openings. Some fistulas are lined by epithelium similar to that of anal gland ducts, but this may also represent epithelium derived from the transitional zone of the anal canal. Persistence may be related more to nonspecific epithelialization of the track than to a chronically infected anal gland.
Recurrent varicose veins: A varicographic analysis leading to a new practical classification
Authors: Stonebridge P A , Chalmers N , Beggs I , Bradbury W , Ruckley C V 
Published: March 2007

Abstract
The varicograms of 128 legs were reviewed by a panel of two vascular surgeons and a radiologist with a specialist vascular interest. Varicography effectively elucidates the anatomical basis of recurrence. Recurrent varicose veins were associated with (i) technically unsatisfactory surgery at the saphenofemoral junction (66 per cent) and (ii) failure to remove the long saphenous vein in the thigh (60 per cent). A new classification is offered as a basis for comparison of series, audit and surgical training.
Management of alimentary tract duplication in children
Authors: Stringer M D , Spitz L , Abel R , Kiely E , Drake D P , Agrawal M , Stark Y , Brereton R J 
Published: March 2007

Abstract
Duplication of the alimentary tract is rare but potentially dangerous. Five of 72 children with alimentary tract duplication treated between 1973 and 1992 died from postoperative complications; a further ten required more than one operation. Heal duplications were the commonest, occurring in 16 patients (22 per cent). Thoracoabdominal duplications were the most complicated and responsible for much of the overall morbidity and mortality. Surgical complications were related to the size and location of the duplication, communication with the gastrointestinal tract or vertebral canal, presence of heterotopic gastric mucosa and involvement of mesenteric vessels. Complete excision of the duplication should be possible in most cases.
Tumour growth stimulation after partial hepatectomy can be reduced by treatment with tumour necrosis factor α
Authors: Slooter G D , Marquet R L , Jeekel J , Ijzermans J N M 
Published: March 2007

Abstract
This study investigated whether partial hepatectomy enhances the growth of experimental liver metastases of colonic carcinoma in rats and whether treatment with recombinant human tumour necrosis factor (TNF) α can reduce this increased growth. Resection of 35 or 70 per cent of the liver was performed in inbred WAG rats, with sham-operated controls (five to eight animals per group). Immediately after surgery 5·105 CC531 colonic tumour cells were injected into the portal vein. After 28 days the animals were killed and the number of liver metastases counted. A 35 per cent hepatectomy induced a significant increase in the median number of liver metastases (28 versus 3 in controls), whereas a 70 per cent resection provoked excessive growth, consistently leading to more than 100 liver metastases and a significantly increased wet liver weight in all animals. TNF-α was given intravenously to rats following 70 per cent hepatectomy or sham operation in a dose of 160 μg/kg three times per week. This had only a marginal effect on tumour development in sham-operated rats but was very effective following partial hepatectomy (median 45 liver metastases). These observations confirm previous findings that surgical metastasectomy may act as a ‘double-edged sword’ by provoking outgrowth of dormant tumour cells and suggest that adjuvant treatment with TNF-α may be of benefit in patients undergoing resection of metastases.
Laparoscopic colonic surgery
Authors: Monson J R T , Hill A D K , Darzi A 
Published: March 2007

Abstract
Laparoscopic surgical techniques have recently entered the field of colorectal surgery. Because the laparoscopic approach has revolutionized biliary surgery, it is hoped that similar advances will be possible in the more elderly population with colorectal disease. Early experience suggests that such advances have not been achieved and there is concern about developing minimal access surgical techniques in the face of potentially curable cancer. This article reviews the current state of knowledge based on published series; however, the current lack of controlled data in patients with extended follow-up makes this area highly controversial. Suggestions regarding the future of laparoscopic surgery are made and include the establishment of a national register and the development of controlled randomized trials.