bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of fine catheter aspiration cytology of the peritoneum as an adjunct to decision making in the acute abdomen
Authors: Vipond M N , Paterson-Brown S , Tyrrell M R , Coleman D , Thompson J N , Dudley H A F 
Published: March 2007

Abstract
Fine catheter aspiration cytology of the peritoneal cavity was performed successfully in 61 patients admitted with acute abdominal pain. Aspirates were examined microscopically and the percentage of neutrophils in the specimen counted. In patients in whom the clinical need for operation was certain (n = 25) all patients required surgery and the peritoneal neutrophil count was &gt;50per cent. In patients in whom the clinical need for operation was uncertain (n = 36) 19 patients required operation: the peritoneal neutrophil count was &gt; 50per cent in 18 and in one patient with ectopic pregnancy fresh blood was aspirated. Of the 17 patients not requiring operation the peritoneal neutrophil count was &lt; 10per cent in 15 and &gt; 50per cent in two patients (both had acute pelvic inflammatory disease). This study confirms peritoneal cytology as a useful adjunct to decision making in those patients with acute abdominal pain in whom the decision to operate is in doubt.
Role of compartmental resection for soft tissue sarcoma of the limb and limb girdle
Authors: Stotter A , Fallowfield M , Mott A , Fisher C , Westbury G 
Published: March 2007

Abstract
A total of 143 consecutive operations for soft tissue sarcoma of the extremity, performed by one surgeon over a 5-year period, was studied to determine the place of compartmental excision. The surgical aim was to achieve the nearest to radical surgery compatible with preservation of a functional limb. Of the operations, 73 were for previously untreated primary tumour and 70 for local recurrence. Two tumours arose in areas previously irradiated for other malignancies and 35 recurrences had occurred despite prior radiotherapy; of the 106 remaining cases, adjuvant radiotherapy was used for 79. Adjuvant chemotherapy was used only occasionally and was more often regional than systemic. For the majority of tumours, compartmentectomy was inappropriate or inadequate: 49 were extracompartmental in origin and 48 extended beyond their compartment of origin at the time of surgery. The remaining 46 were confined to one compartment; in only 21 of these 46 operations was a radical compartmental excision performed. Compartmental excision was more likely to be performed when the tumour was centrally located within a compartment, was so large that it replaced most of the muscle group, or was high grade or recurrent (particularly when adjuvant radiotherapy had already been used). The general preference was to combine less-than-radical surgery with adjuvant radiotherapy rather than sacrifice entire muscle groups or adjacent, functionally important, structures such as artery or nerve. This reflects the proven efficacy of radiotherapy in controlling microscopic disease. Overall, compartmental excision was considered appropriate in only 15per cent of operations.
Photodynamic therapy for colorectal cancer: A quantitative pilot study
Authors: Barr H , Krasner N , Boulos P B , Chatlani P , Bown S G 
Published: March 2007

Abstract
Ten patients with colorectal cancers unsuitable for operation were treated with endoscopic photodynamic therapy (PDT). The patients were assessed before treatment, and at 1 week and 1 month after treatment by colonoscopy with biopsy and endoluminal ultrasound examination. The depth of tumour was measured and the effect of PDT was quantified by measuring the reduction in tumour depth. All patients were sensitized with 2·5mg kg−1 of haematoporphyrin derivative, 48h before phototherapy. A standard treatment protocol of light exposure was used. Up to four parts of the tumour were treated with 50 J of red light (630 nm) from a tuneable dye laser, through a flexible optical fibre passed through the colonoscope and inserted into the tumour. Two patients with small lesions are tumour-free 20 and 28 months after PDT. One treatment of an advanced tumour was complicated by a haemodynamically significant secondary haemorrhage. PDT may be most suitable for the treatment of small tumours or for small areas of persistent tumour where the bulk has been removed by alternative techniques.
Blood transfusion and survival following surgery for prostatic carcinoma
Authors: McClinton S , Moffat L E F , Scott S , Urbaniak S J , Kerridge D F 
Published: March 2007

Abstract
Blood transfusion in the perioperative period has been reported to have a detrimental effect on survival in many types of cancer. Other studies have failed to confirm this. We have examined retrospectively the records of 246 patients with prostatic carcinoma who underwent transurethral resection of the prostate (TURP) in Aberdeen Royal Infirmary between 1977 and 1982. Bilateral orchiectomy (BLO) was performed in 193 patients. Of these patients, 71 of 246 (29 per cent) received perioperative blood transfusion. After controlling for differences due to a number of variables, transfusion of non-autologous blood was shown to be associated with a significant negative effect on survival. Perioperative transfusion of non-autologous blood should be avoided in patients with malignancy, unless there are clear overriding clinical indications. Prospective trials are needed urgently.
Results of surgical treatment of neonatal necrotizing enterocolitis
Authors: Jackman S , Brereton R J , Wright V M 
Published: March 2007

Abstract
In 6 years, 74 neonates were treated for necrotizing enterocolitis, 40 (54 per cent) of whom underwent operation. The early postoperative mortality rate was 23 per cent and there was one late death. Of the 30 postoperative survivors, two have short bowel syndrome, two have chronic respiratory disease, two are partially sighted, and five (17 per cent) have severe developmental delay. Only 15 (50 per cent) survivors enjoy good health.
Surgical correction of the efferent ileal limb for disordered defaecation following restorative proctocolectomy with the S ileal reservoir
Authors: Nicholls R J , Gilbert J M 
Published: March 2007

Abstract
The S ileal reservoir has been superseded in this unit but 76 patients had this operation between 1976 and 1983. Forty-one (54 per cent) patients had to catheterize the reservoir to evacuate faeces and this was primarily due to the long efferent ileal limb. In six patients, the need to catheterize and other problems with defaecation were such that surgical correction of the efferent ileal limb was undertaken. These six patients are reported. Presenting features were the need to catheterize the reservoir, difficulty in catheterizing, faecal incontinence, stenosis of the efferent ileal limb and transanal prolapse of the efferent ileal limb. All patients had an excessively long efferent ileal limb of 8cm or more which was resected and reanastomosed to the anal canal. The resection was performed endoanally in three patients but was successful in only one. In the two patients in whom endoanal excision was unsuccessful and in the remaining three resection of at least 5 cm was performed transabdominally with endoanal reanastomosis. Three of these five patients were converted from catheterizing the reservoir to spontaneous evacuation, but two patients still needed to catheterize. All six patients benefited in terms of the need for, or frequency of, catheterization, or by improvement in continence. Excessive length of the efferent limb of an S ileal reservoir may cause unsatisfactory defaecation, which may be improved by partial resection. The transabdominal route is recommended for the resection, with endoanal reanastomosis. This surgery is potentially problematic and, although no anastomotic leakage was encountered, a covering loop ileostomy is recommended.
Role of intraoperative prograde colonic lavage and a decompressive loop ileostomy in the management of transmural amoebic colitis
Authors: Luvuno F M 
Published: March 2007

Abstract
A prospective analysis is presented of a selected group of 45 consecutive patients with transmural amoebic colitis treated by laparotomy, colonic lavage and ileostomy (phase 1 surgery) over 3 years. The diagnosis of amoebic colitis and amoebic perforation of the bowel were difficult and therefore all patients with ‘acute abdomen’ had proctosigmoidoscopy and a trial of metronidazole for 24–48 h before laparotomy. At laparotomy, adhesive wraps were present in all patients; 13 perforations were exposed by inadvertent disturbance of adhesive wraps but were successfully closed by suture to any available organ in close proximity, such as the amentum or small bowel. Four patients (9 per cent) died after phase 1 surgery. After 6 weeks when the acute disease had healed, 33 of the remaining 41 patients (80 per cent) required closure of ileostomy only, five had resection of stricture and three (7 per cent) needed stricturoplasty (phase 2 surgery). Two patients (5 per cent) died after phase 2 surgery. Thus, in surgery for transmural amoebic colitis adhesive wraps should not be disturbed as they mechanically protect the peritoneal cavity from faecal soiling when perforation occurs. The colon should be emptied by lavage and the faecal stream diverted to avoid secondary bacterial effects.
Endoscopic sphincterotomy for the palliation of ampullary carcinoma
Authors: Bickerstaff K I , Berry A R , Chapman R W , Britton B J 
Published: March 2007

Abstract
Palliative endoscopic sphincterotomy was performed on 17 patients with adenocarcinoma of the ampulla of Vater. An endoprosthesis was inserted immediately after the sphincterotomy in four of the patients. Fourteen patients made uncomplicated recoveries from the procedure and their jaundice resolved completely. Early complications developed in three patients. One patient died from haemorrhage. Two patients, both of whom had an endoprosthesis, developed cholangitis. The endoprosthesis was removed and another inserted in one patient and the other underwent surgery. Both thereafter made uncomplicated recoveries. Jaundice subsequently recurred in eight patients and further endoscopic treatment was successful in five of these patients. Eleven patients died between 4 days and 23 months after the sphincterotomy with a median survival of 12 months. Four patients remain alive between 3 and 17 months after treatment. The results indicate that reasonable palliation can be achieved safely by endoscopic sphincterotomy.
Intact parathyroid hormone in primary hyperparathyroidism
Authors: Flentje D , Schmidt-Gayk H , Fischer S , Stern J , Blind E , Buhr H , Herfarth Ch 
Published: March 2007

Abstract
In 49 patients with primary hyperparathyroidism, intact parathyroid hormone (PTH) was measured with a recently developed immuno-radiometric assay, and midregional PTH fragments (sequence 44–68) were measured with an established radioimmunoassay technique. In 47 normal subjects, the concentration of intact PTH ranged from 2·0 to 6·8pmol/l, and in 49 patients with primary hyperparathyroidism it ranged from 6·4 to 80·0 pmol/l. In contrast, midregional PTH fragments were normal in seven of 49 patients with primary hyperparathyroidism. In five healthy controls and in 12 patients with surgically confirmed primary hyperparathyroidism and serum calcium levels below 3·0 mmol/l, a rapid calcium loading test was performed. In healthy controls, intact PTH was in the low normal to subnormal range within 2·5–5·0 min, and had recovered within 15 min of calcium infusion. In patients with primary hyperparathyroidism, the calcium infusion also led to a 30–50 per cent decrease in intact PTH levels within 5·0–7·5 min after injection, with a slow recovery after 10–15 min. In six of the patients with only slightly elevated basal intact PTH, a suppression to the normal range was observed. In 24 patients (16 patients with a solitary adenoma and eight patients with four-gland hyperplasia) the intact PTH levels were followed intraoperatively during para-thyroidectomy, revealing a significantly different rate of decline for single adenomas compared with hyperplasia during the first 15 min after removal of the primary enlarged gland. Intact PTH values remained constantly elevated in one patient with primary hyperparathyroidism and an unsuccessful neck exploration. These results confirm that (a) the measurement of intact PTH in patients with primary hyperparathyroidism is superior to the measurement of midregional fragments; (b) PTH secretion in primary hyperparathyroidism is not totally autonomous; and (c) intraoperative monitoring of intact PTH values could be used to monitor the success of surgery.
Tissue plasminogen activator in peripheral arterial thrombolysis
Authors: Berridge D C , Gregson R H S , Makin G S , Hopkinson B R 
Published: March 2007

Abstract
Thirty acute peripheral arterial thromboses in 28 patients were treated with local low-dose intra-arterial recombinant tissue plasminogen activator (t-PA). All patients received 0·5 mg h−1 t-PAand 15 also received 250 units h−1 of intra-arterial heparin. Overall limb salvage at 30 days was 83 per cent (25 out of 30 limbs). Mean(s.d.) ankle/brachial index was increased by 0·53(0·26) and there was no significant difference between the group receiving t-PA alone and that receiving t-PA and heparin. No strokes or major haemorrhages occurred but there were four (13 per cent) minor haematomas associated with the catheter entry site. There were four (13 per cent) deaths from myocardial infarction occurring between 5 and 21 days after treatment. Rethrombosis occurred in four cases (13 per cent). In two patients following t-PA alone, rethrombosis occurred after 2 and 11 days. Limb salvage was achieved with a successful repeat thrombolysis and a femoropopliteal graft respectively. Rethrombosis after t-PA and heparin occurred after 30 days in two patients due to poor run-off and extensive proximal atheromatous disease respectively. t-FA is a safe, effective thrombolytic agent when given as a low-dose intra-arterial infusion. The addition of low-dose heparin does not produce any significant benefit.
Aortoiliac endarterectomy: An 11-year review
Authors: Naylor A R , Ah-See A K , Engeset J 
Published: March 2007

Abstract
Fifty-seven patients underwent aortoiliac endarterectomy over an 11-year period, the majority (86 per cent) for disabling daudication. No patient died within 30 days of surgery, but nine patients suffered significant complications. The cumulative survival rate was 98 per cent at 1 year, and was 94 and 78 per cent at 5 and 10 years respectively. Cumulative operated segment patency rates were 92 per cent at 5 years and 68 per cent at 10 years. There was no significant difference in survival rates between patients who smoked after surgery and those who did not, but smokers had significantly worse rates for cumulative patency, limb failure and symptom status than non-smokers. Twenty-seven patients developed worsening symptoms during follow-up and 24 patients required secondary vascular intervention. Fourteen patients subsequently required aortofemoral bypass and the largest single cause of operated segment failure was recurrent disease in the external iliac artery. Our evidence suggests that, while aortoiliac endarterectomy should be considered in young patients with localized disease not involving the external iliac artery, those who do not fit these criteria should be considered for primary aortofemoral bypass. Regardless of the choice of operation, the chance of success is jeopardized if the patient continues to smoke.
Simultaneous aortic and renal artery reconstruction
Authors: Cooper G G , Atkinson A B , D'Sa A A B Barros 
Published: March 2007

Abstract
Nine patients presenting with combined aortic and renal artery disease underwent simultaneous infrarenal aortic reconstruction and renal revascularization. Seven patients had aneurysmal and two had occlusive aortic disease in association with unilateral (four cases) or bilateral (five cases) atheromatous renal artery stenosis. The indications for renal revascularization were hypertension (n = 8) refractory to medical treatment or associated with renal functional impairment and chronic renal failure alone (n = 1). Five patients developed postoperative complications with one fatality. Eight patients were followed up for between 7 months and 4 years. Control of blood pressure had improved in six of seven hypertensive patients. Serum creatinine levels were stabilized or had fallen in five patients. Simultaneous aortic and renal artery reconstruction is widely recognized as having a high postoperative morbidity rate but can improve control of hypertension and stabilize renal function in carefully selected patients.
Monocyte HLA-DR antigen expression characterizes clinical outcome in the trauma patient
Authors: Hershman M J , Cheadle W G , Wellhausen S R , Davidson P F , Polk H C 
Published: March 2007

Abstract
Immunological assessment is important to characterize the host defence response of trauma patients as infection is the most common cause of severe morbidity and late death. Sixty trauma patients were followed serially and divided into three groups: those with an uneventful recovery (n = 17), those with recovery after major sepsis (n = 27) and those who died (n = 16). The ability of peripheral blood monocytes to express the antigen HLA-DR was measured and compared to the results from 77 asymptomatic volunteers. After initial injury, there was a significant reduction from normal in the three trauma groups. It took one week for HLA-DR antigen expression to return to the normal range in the first group, three weeks in the second group, and in the third group it never returned to normal. Monocyte HLA-DR antigen expression, after incubation with lipopolysaccharide, distinguished those patients who survived from those who died. There was no difference in HLA-DR antigen expression between a high transfusion group of 31 patients who received 10 or more units of blood and a low transfusion group of 29 patients who received less than 10 units. The ability of monocytes to express HLA-DR antigen correlated directly with the clinical course in these patients and its measurement identified a group of patients at high risk of infection and death following trauma.
Self protection in surgery: The use of double gloves
Authors: Dodds R D A , Barker S G E , Morgan N H , Donaldson D R , Thomas M H 
Published: March 2007

Abstract
This study assesses the perforation rate of single and double gloves and thus the extent to which double gloving protects the surgeon from diseases transmissible from the patient. We have also investigated whether double gloving offers the patient extra protection by reducing wound sepsis. Two hundred adult hernia repairs were performed, the first 100 single gloved and the second 100 double gloved. Glove perforation rates were not significantly different between single gloves and the outer of the double gloves. Although 46 of 400 outer gloves were perforated there were only 15 inner glove perforations and only eight of these matched the outer perforations. The percentage of operations in which the latex protective barrier was breached was reduced from 31 per cent when the surgeon wore single gloves to 8 per cent with double gloves. Wound sepsis was not increased by glove perforation nor reduced by double gloving. While careful technique remains mandatory we conclude that double gloving offers increased protection to the surgeon operating on high risk infectious cases.
Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics
Authors: Sabanathan S , Mearns A J , Smith P J Bickford , Eng J , Berrisford R G , Bibby S R , Majid M R 
Published: March 2007

Abstract
To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P &lt; 0·01) and required less papaveretum (P &lt; 0·01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P &lt; 0·01). Restoration of pulmonary function was superior in the bupivacaine group (P &lt; 0·01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.
Repeat hepatic resections for colorectal metastases
Authors: Griffith Kean D , Sugarbaker Paul H , Chang Alfred E 
Published: March 2007

Abstract
We identified 106 patients who had undergone complete resection of isolated colorectal hepatic metastases. Nine of these patients subsequently underwent repeat liver resections for isolated hepatic recurrences. The median follow-up for these patients was 21 months. One postoperative death was related to the second hepatectomy. At the time of last follow-up, five patients were alive and free of recurrent disease at 9, 19, 31, 50, and 67 months after their second hepatic resection. The remaining three patients were alive, but disease had recurred 11 months after resection in the first patient, 12 months after resection in the second, and 18 months after resection in the third. Among these three patients, two had solitary pulmonary nodules, which were resected, and one had unresectable liver disease. Our experience and a review of the literature suggest that repeat hepatic resection for isolated colorectal metastases can result in long-term survival in selected patients.