bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transformation of blood monocytes to giant cells in vitro from patients with breast cancer
Authors: Al-Sumidaie A M , Leinster S J , Jenkins S A 
Published: March 2007

Abstract
Monocytes from patients with breast cancer and from control subjects were cultured under agarose for 6 days. Giant cell formation occurred in 32 out of the 36 patients with breast cancer (89 per cent). In contrast giant cell formation was only observed in two of the control subjects (6 per cent). Menstruation and menopause had no effect on giant cell formation. Furthermore, under the experimental conditions of this study, it seems unlikely that serum factors, lymphokines or phagocytic stimulators induced giant cell formation. The results therefore, suggest that giant cell formation may be initiated by viruses already present in the monocytes from patients with breast cancer. Further studies are required to confirm this hypothesis and to elucidate the significance of giant cell formation in the pathogenesis of breast cancer.
Carotid endarterectomy in Great Britain and Ireland
Authors: Murie J A , Morris P J 
Published: March 2007

Abstract
A survey of the practice of carotid surgery by 245 vascular and neurological surgeons in Great Britain and Ireland was conducted with a 96 per cent response. Ninety-six surgeons (41 per cent) performed at least one carotid endarterectomy in 1984 and a total of 1374 such operations were carried out in that year. The indications for carotid endarterectomy in order of frequency were transient ischaemic attack, minor stroke and stroke. Operation was hardly ever undertaken for asymptomatic carotid bruit. Eighty-six per cent of surgeons who performed carotid endarterectomy generally assessed patients in the first instance using techniques less invasive than conventional angiography, principally Doppler ultrasonography or digital subtraction angiography. Nevertheless, conventional angiograms were usually performed before surgery by 89 per cent of surgeons. Almost all surgeons operated only under general anaesthesia, while opinion on the use of an intraluminal shunt during carotid endarterectomy was divided. Despite an increase in the number of carotid endarterectomies in recent years, this operation is currently performed nineteen times less frequently in Great Britain and Ireland than in the USA. The reasons for this are explored and certain controversies surrounding carotid endarterectomy are discussed.
Secondary aorto-enteric fistulae: Towards a more conservative approach
Authors: Thomas W E G , Baird R N 
Published: March 2007

Abstract
Eight cases of secondary aorto-enteric fistulae are presented occurring 9 months to 10 years after aortic Dacron grafting. In four patients there was a simple fistula between the anastomosis and the adherent duodenum, three patients had clinically infected grafts and one had a false aneurysm that had ruptured into the bowel. The four patients with a simple fistula had direct suture repair of the defect. One developed a recurrent fistula at 2 months and was successfully repaired again by direct suture. All four patients remain well at a follow-up of 1–5 years. The other four patients had the grafts excised, with local regrafting in two cases, both patients remaining well at follow-up. One patient had an axillo-bifemoral graft, but died at 30 days of overwhelming sepsis. The final patient, a girl with diffuse aneurysmal disease, had the aortic stump oversewn but no reconstruction. She died at 9 months of aortic stump disruption. These results suggest that a more conservative approach to the operative correction of secondary fistulae should be used wherever possible.
Combined topical povidone–iodine and systemic antibiotics in postappendicectomy wound sepsis
Authors: Lau W Y , Fan S T , Chu K W , Yip W C , Chong K K , Wong K K 
Published: March 2007

Abstract
Three hundred and fifteen patients with appendicitis were randomized into two groups. One group received pre-operative systemic gentamicin and metronidazole while the other group received 1 per cent topical povidone–iodine solution in addition to the antibiotics. For early appendicitis including normal and acutely inflamed appendices, only one dose of antibiotics was used. The postoperative wound sepsis was very low in both groups of patients and there was no statistical difference between them. For late appendicitis including gangrenous and perforated appendices, the antibiotics were continued for 7 days. Eight out of 51 patients who had the topical agent developed wound sepsis compared with one out of 52 patients who received no topical agent. This difference is statistically significant (P = 0·03). All wound infections presented within 2 weeks of operation and were deep. Povidone–iodine, 1 per cent, adversely affects the wound infection rate in late appendicitis and should not be used.
Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage
Authors: Clason A E , Macleod D A D , Elton R A 
Published: March 2007

Abstract
Data collected prospectively from 326 admissions for acute upper gastrointestinal haemorrhage were examined to identify factors predicting further haemorrhage or mortality. Seven predictive factors were identified by univariate analysis for both further haemorrhage and/or mortality, but only age over 60 years, an admission haemoglobin &lt;8 g/dl and the presence of endoscopic stigmata of recent haemorrhage were shown by stepwise logistic regression to have independent significance for further haemorrhage. An age over 60 years, the presence of clinical shock on admission and an episode of further haemorrhage following admission emerged as independently significant in the prediction of mortality.
Management of acute cholangitis and the impact of endoscopic sphincterotomy
Authors: Leese T , Neoptolemos J P , Baker A R , Carr-Locke D L 
Published: March 2007

Abstract
Ninety-four patients admitted to Leicester Hospitals with acute cholangitis since 1977 were reviewed to coincide with the availability of endoscopic sphincterotomy (ES). Thirty-four were men and sixty were women, their mean age was 69·7 years and the median hospital stay was 20 days. There were 15 deaths (16 per cent) by 30 days in patients with significantly lower initial serum albumin levels (P &lt; 0·005) and significantly higher serum urea levels (P &lt; 0·05) than survivors. Eighty-two patients had common bile duct (CBD) calculi of whom 71 underwent early decompression of the biliary tree either surgically (28) or by ES (43). Early surgical decompression was associated with a significantly higher 30 day mortality (6/28) than early ES (2/43) (P &lt; 0·02) despite the fact that patients undergoing early ES were significantly older (P &lt; 0·02) and had significantly more medical risk factors (P &lt; 0·05). Of the 43 patients undergoing early ES 7 had had a previous cholecystectomy, 13 underwent subsequent elective cholecystectomy with no mortality and the remaining 23 had the gallbladder left in situ because of advanced age (mean age 79 years) and frailty. Only 2 of the 23 have since required cholecystectomy. We suggest that patients with acute cholangitis who do not rapidly respond to conservative treatment should undergo early ES with early surgery reserved for those who do not improve following ES. Elective cholecystectomy following successful ES can often be avoided in the elderly and frail.
Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: A prospective clinical trial
Authors: Monson J R T , MacFie J , Irving H , Keane F B V , Brennan T G , Tanner W A 
Published: March 2007

Abstract
In this prospective randomized study, the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collections occurring in patients after acute or elective cholecystectomy was assessed by ultrasound examination. A total of 112 patients entered the study, of whom 54 received a drain. There was no significant difference between the drainage and the non-drainage groups with respect to mean age or sex distribution, the number of patients in whom the gallbladder bed was formally closed (27 versus 21) nor in the number of acute cholecystectomies performed in either group (12 versus 13). Ultrasound detected 10 (18 per cent) collections in the drainage group and only one (1·8 per cent) in the non-drainage group (P &lt; 0·01, χ2 test). None of the collections required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid. These results suggest that rather than preventing fluid collections, suction drains may predispose to the development of subhepatic collections after cholecystectomy.
Diagnostic value of serum elastase 1 in pancreatic disease
Authors: Gullo L , Ventrucci M , Pezzilli R , Platé L , Naldoni P 
Published: March 2007

Abstract
We studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty-nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancreas, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non-pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic disease.
Auditing the vascular surgical audit
Authors: Campbell W B , Souter R G , Collin J , Wood R F M , Kidson I G , Morris P J 
Published: March 2007

Abstract
The results are presented of vascular surgical audits in Oxford over the 10 years 1975–85. Changes observed include the decreasing use of endarterectomy (other than carotid), the introduction of transluminal angioplasty, and fewer lumbar sympathectomies. The number of major amputations has increased relative to arterial reconstructions. Our audit methods over the 10 years included the use of punch cards, two different computer programs, and a simple weekly audit of cases. The relative merits of these methods are compared. Numbers of procedures performed in Oxford were compared with expected figures calculated from the Hospital In-patient Enquiry, the Lothian audit, and the Vascular Surgical Society survey. In general the calculated and actual numbers are similar. Difficulties in finding comparable operation categories and the totally inadequate classification of nationally collected data highlight the need for improved audit in vascular surgery.
Pancreatic resection for carcinoma of the pancreas and the periampullary region in patients over 70 years of age
Authors: Kairaluoma M I , Kiviniemi H , Ståhlberg M 
Published: March 2007

Abstract
This study was undertaken to elucidate whether or not resection for cancer of the pancreas and the periampullary region can be performed with an acceptable survival rate in patients over 70 years of age (n = 21) as compared with patients under 70 years of age (n = 47), and whether resection provides an improvement in their prognosis and longevity. The operative mortality for patients over 70 years of age and under 70 years was 10 and 9 per cent respectively and the cumulative 5 year survival 12±11 and 20±9 percent respectively. The median survival was 11 months in both groups. It was concluded that an age of 70 years or more is not an absolute contra-indication for pancreatic resection. Prognosis is related to tumour histology.
Prognostic significance of the DNA content of human breast cancer
Authors: Dowle C S , Owainati A , Robins A , Burns Karen , Ellis I O , Elston C W , Blamey R W 
Published: March 2007

Abstract
The DNA content of paraffin embedded primary tumour tissue has been measured by flow cytometry in 354 patients with operable breast cancer. Tumour ploidy significantly correlated with tumour size, histological grade, and with menopausal status. No significant correlation with oestrogen receptor status or lymph node involvement was found. Patients with diploid cancers had a significantly improved short term survival and disease-free interval (DFI) compared with patients having aneuploid tumours. However, no difference in survival or DFI was shown after longer term follow-up (median 84 months). Multivariate analysis showed no independently significant prognostic value for tumour ploidy. No patient in this study received adjuvant therapy.
Chloroquine administration for malaria suppression after abdominal surgery
Authors: Schweizer W , Stahel E , Betschart B , Mwakilasa A , Burnier E , Stutz P , Tanner M 
Published: March 2007

Abstract
Administration of chloroquine after major surgery is indicated in malaria endemic areas. In emergencies it is commonly administered parenterally after the operation. The present study, undertaken at St. Francis Hospital, Ifakara (Kilombero District), Tanzania, compared plasma chloroquine levels after oral and subcutaneous administration of 300 mg of chloroquine base in 14 patients after abdominal, non-bowel-resective surgery and in 12 controls. There were no significant differences in the plasma chloroquine levels of all groups, and the chloroquine concentrations reached suppressive levels for at least 3 days (&gt; 0·1 nmol/ml). Oral administration was well tolerated in both patients and controls. In all areas where the Plasmodium strains are still sensitive to chloroquine and where parenteral chloroquine may not be easily available, oral chloroquine represents a cheap, easy and safe alternative for postoperative prophylactic malaria suppression. It can be applied after abdominal non-bowel-resective emergency surgery.
Recurrent pancreatitis contributing to choledochal cyst formation
Authors: Ng W D , Chan Y T , Fung H 
Published: March 2007

Abstract
We report three cases of choledochal cyst. The calibre of the common bile duct in each of them was demonstrated by ultrasonogram, CT scan, radiography and laparotomy to be almost normal before recurrent attacks of pancreatitis, following which the common bile duct was shown to become grossly dilated. This observation leads us to surmise that recurrent pancreatitis contributes to the formation of choledochal cysts.
Distal arterial bypass by composite grafting
Authors: Britton J P , Leveson S H 
Published: March 2007

Abstract
The use of non-autogenous prostheses for femorodistal grafting has been attended by relatively poor patency rates. We have attempted to improve on these disappointing results by fashioning a composite graft using expanded PTFE (GORE-TEX) and transposed non-reversed saphenous vein, placed between the femoral artery and anterior tibial artery. We report the early results using this technique in 25 critically ischaemic limbs. At 12 months, the cumulative graft patency for this group of patients was 65 per cent (mean follow-up of 19 months). Eighteen of the twenty-five limbs were saved and there was no mortality. This technique offers a useful alternative to other forms of distal grafting and appears superior to the results obtained using non-autogenous femorodistal conduits.
Secondary arterio-enteric fistulae: A surgical challenge
Authors: Umpleby H C , Britton D C , Turnbull A R 
Published: March 2007

Abstract
Ten cases of secondary arterio-enteric fistulae are described. There were nine graft enteric fistulae and one fistula involving the aortic suture line following elective resection of an infected graft. Only four of the patients initially received prophylactic antibiotics (single dose) at the original aortic reconstruction, and the vascular suture line had only been protected in two. Eight patients presented with bleeding and two with groin abscesses. One patient died before operation. Graft resection was undertaken in all patients and organisms were grown from six of eight grafts cultured. No patient died during operation but one died after 3 days. Axillofemoral bypass grafts were constructed in seven patients (four immediately after resection of prosthetic grafts and three within 4 days of operation). Only three of the eight patients who survived operation are still alive; two died of a ruptured aorta and one from a recurrent fistula. Two patients died of other causes. Four of five axillofemoral grafts in surviving patients subsequently occluded.
Assessment of perfusion in postoperative patients using tissue oxygen measurements
Authors: Jonsson K , Jensen J A , Goodson W H , West J M , Hunt T K 
Published: March 2007

Abstract
Subcutaneous tissue oxygen tension was measured as an index of perfusion in 44 postoperative patients. Hypoperfusion was defined as suboptimal tissue oxygen tension unresponsive to increased inspired oxygen but becoming responsive after increased fluid infusion. Twelve of thirty patients who underwent major abdominal and flank operations were found to be suboptimally perfused by this definition despite adequate fluid maintenance according to standard clinical criteria including urine output. Apparently, a significant number of postoperative abdominal surgery patients are not optimally perfused, and this state is not recognized by the present clinical criteria. Tissue oximetry may be a useful objective method of assessing tissue perfusion.
Combination fine-needle aspiration cytology and intrarenal manometry at the onset of renal dysfunction
Authors: Ubhi C S , Guillou P J , Davison A M , Giles G R 
Published: March 2007

Abstract
Twenty-three consecutive cadaveric renal allograft recipients immunosuppressed with cyclosporin have been monitored three times a week by fine-needle aspiration cytology and intrarenal manometry until discharge from hospital or until 30 days post-transplant. Standard criteria were used to determine the cause of allograft dysfunction. The onset of allograft rejection was marked by an elevation of the total corrected increment score by fine-needle aspiration cytology in 80 per cent of rejection episodes whereas intrarenal pressure was raised in only 46·6 per cent. However, intrarenal pressure was greater than 40 mmHg on a single occasion in 16 measurements performed on allografts showing evidence of cyclosporin nephrotoxicity. By combining fine-needle aspiration cytology and intrarenal manometry the sensitivity of these tests for allograft rejection was increased to 93·3 per cent at the onset of renal dysfunction. Our results demonstrate that fine-needle aspiration cytology is more sensitive than intrarenal manometry as a single investigation. However, the combined test may have an important role in the differentiation of allograft rejection and cyclosporin nephrotoxicity in the early management of renal allograft recipients.
Splenic injury: A prospective multicentre study on non-operative and operative treatment
Authors:   The Splenic Injury Study Group, Kirurgisk J N 
Published: March 2007

Abstract
One hundred and forty-seven patients with splenic injury admitted to 18 different hospitals were included in a prospective multicentre study. The spleen was saved in 64 per cent. Out of the total series, 43 per cent of patients were not operated upon, 5 per cent had exploratory laparotomy only, and in 16 per cent splenic repair was performed. Treatment is discussed with reference to the nature of the splenic lesion, concomitant injuries, amount of blood transfusion given, and age of the patient. No deaths were definitely related to the splenic injury. The frequency of serious recurrent bleeding was not higher in the splenic salvage group when compared with the splenectomy group. Delayed bleeding was detected in 4 per cent of the patients. The mode of treatment varied considerably in different hospitals in that conservative treatment was performed in 14, splenic repair in 10 and splenectomy in 12 hospitals. Splenic salvage seems safe in most patients with a splenic injury. However, meticulous surveillance of the patient is mandatory.
Spleen-saving procedures in paediatric splenic trauma
Authors: Büyükünal C , Danişmend N , Yeker D 
Published: March 2007

Abstract
The aim of this study is to assess the advantages of ‘spleen-saving procedures’ in paediatric splenic trauma. Since January 1979, 87 children with splenic trauma were treated. Six were treated without operation. Eighty-one patients were treated surgically. Sixteen cases with type I splenic injury were subject to simple splenorrhaphy, and twenty-three cases with type II splenic injury underwent splenorrhaphy plus omentoplasty. Twenty-four cases had type III splenic injury; of these, 20 were treated by ligation of the splenic artery (the main splenic artery in 14 cases and the upper segmental artery in six cases) with splenorrhaphy and omentoplasty, and the remaining four cases were treated by partial splenectomy and omentoplasty. In 16 of the 18 patients with type IV splenic injury, splenectomy was inevitable and heterotopic splenic autotransplantation was added. In the remaining two cases, it was possible partially to preserve the spleen. No complication was observed due to any of these spleen-saving procedures. Moreover, splenic implants increased complement C3 levels and improved filtration function. Despite other injuries, the mortality rate of this group was 5·7 per cent. The splenic salvage rate was 82 per cent.
Mucosal proctectomy and coloanal anastomosis for distal ulcerative proctocolitis
Authors: Varma J S , Browning G G P , Smith A N , Small W P , Sircus W 
Published: March 2007

Abstract
Four patients with long-standing symptomatic ulcerative colitis confined to the left colon and rectum were treated by resection, mucosal proctectomy and colo-anal sleeve anastomosis. There was no operative mortality or anastomotic leakage. Follow-up has ranged from 12 to 66 months (mean 52 months). Loose bowel motions with urgency and frequency of defaecation were troublesome postoperative symptoms. Recurrence of the colitis in the neorectum with extension into the proximal colon occurred in all patients within 3 to 11 months (mean 6 months) of operation. This necessitated total proctocolectomy with ileostomy in three patients (mean 18 months postoperatively). In the fourth patient the recurrence is medically controlled without a stoma more than 5 years after operation. This operation is unsuitable for the treatment of segmental ulcerative proctocolitis.
Postanal repair and intersphincteric Ivalon sponge rectopexy for the treatment of rectal prolapse
Authors: Rogers J , Jeffery P J 
Published: March 2007

Abstract
Twenty-four consecutive patients (mean age: 74 years) with complete rectal prolapse, fifteen of whom were incontinent of solid stool, have been treated by postanal repair and intersphincteric Ivalon sponge rectopexy. There was no operative mortality, or serious morbidity. There was one recurrence of complete prolapse which occurred 14 days after operation. The other 23 patients have been followed for up to 4 years. All patients who were incontinent of solid stool pre-operatively have been rendered continent. This type of operation may be the treatment of choice in the elderly, where an abdominal procedure is considered unwise and in cases of rectal prolapse associated with faecal incontinence.