bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasodilatory capacity of the skin in venous disease and its relationship to transcutaneous oxygen tension
Authors: Cheatle T R , Stibe E C L , Shami S K , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
Low transcutaneous oxygen tension (Ptc,O2) values in the supramalleolar skin of patients with venous disease are often reported. This measurement involves heating the skin to 43°C to cause maximum vasodilatation and is valid only if liposclerotic and normal skin can vasodilate to the same degree. Forty-four limbs were studied, 15 with lipodermatosclerosis (LDS), 14 with uncomplicated varicose veins, and 15 controls. A Ptc,O2 electrode was modified to incorporate a laser Doppler probe. Laser Doppler flux was measured in the supramalleolar skin before and after local heating to 43°C and the relative increase in flux was measured. The Ptc,O2 was then measured at the same site and on the chest. Vasodilatory capacity was expressed as the ratio of peak:basal laser Doppler flow, and the Ptc,O2 was expressed as a leg:chest ratio. Median laser Doppler flow was higher in limbs with LDS (median 67 mV) than in normal limbs (median 40 mV) (P&lt;0·03). Ptc,O2 was higher in control limbs (median ratio 0·94) than in limbs with LDS (median 0·53) (P &lt; 0·006). The microcirculation in LDS had less capacity to vasodilate after heating (median factor of increase 5·4) than normal skin (median factor of increase 12·3) (P&lt;0·001). A simple regression analysis was performed on all pairs of data, and revealed a correlation between Ptc,O2 and vasodilatory capacity (r = 0·524, P&lt;0·001). The results indicate that low Ptc,O2 levels in venous disease reflect an inability of the microcirculation to increase its flow in response to local heating; inferences about the oxygen content of liposclerotic skin at normal temperatures cannot be drawn using this technique.
Groin wound infection after arterial surgery
Authors: Newington D P , Houghton P W J , Baird R N , Horrocks M 
Published: March 2007

Abstract
Fifty-six patients, 30 with superficial and 19 with deep groin wound infections, and seven with lymph fistulae with positive cultures within 30 days of arterial surgery, were identified after 661 operations (873 groins at risk) between September 1984 and August 1988. The commonest infecting organisms were Staphylococcus aureus, Pseudomonas aeruginosa and Proteus spp. In 33 patients the infection settled completely after treatment with culture specific antibiotics. These were given intravenously then orally for up to 6 weeks. Sixteen patients required debridement and excision of necrotic wound edges, including one who had an antibiotic infusion into the wound. Graft excision was performed in seven patients of whom five received an extra anatomic bypass. The need for graft excision was much greater (six versus one) for Dacron® and/or polytetrafluoroethylene than for vein. In two lymph fistulae sartorius transposition and wound resuture were used. All groins healed, though three extremities were ischaemic following occlusion of the bypass. There were two deaths, one from myocardial infarction and one from pulmonary embolism and no major amputations. These results suggest that most infective groin problems may be successfully managed conservatively and that radical graft excision is only necessary for a few intractable cases.
Clinical outcome and health care costs in renal revascularization — percutaneous transluminal renal angioplasty versus reconstructive surgery
Authors: Weibull H , Bergqvist D , Jendteg S , Lindgren B , Persson U , Jonsson K , Bergentz S E 
Published: March 2007

Abstract
Clinical outcome and health care costs related to investigation, treatment with either percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery, and follow-up of patients with renovascular hypertension with or without uraemia were analysed in 21 PTRA-treated and 16 operated patients. Most renal artery stenoses were atherosclerotic. Nineteen PTRAs were successful or partly successful and two failed; the patients were operated on without delay. All surgical reconstructions were successful. In the PTRA group six restenoses occurred after 4–24 months. Four were treated with re-PTRA and two were operated on. No recurrence occurred in the operated group. At the end of follow-up (median 48, range 9–84 months) primary patency in the PTRA group was 69 per cent and in the operated group 100 per cent. Secondary patency in the PTRA group was 100 per cent. With regard to hypertension, including primary and secondary results, 19 out of 21 (90 per cent) patients were improved in the PTRA group and 13 out of 16 (81 per cent) in the operated group. The diagnostic and preprocedure costs were the same in both groups, whereas the procedure and postprocedure costs were lower in the PTRA group. However, the follow-up costs were considerably higher because of recurrences and their treatment in the PTRA group. The total median cost of reconstructive surgery was 12 per cent higher than for PTRA, a non-significant difference.
Haemodynamic significance of incompetent calf perforating veins
Authors: Zukowski A J , Nicolaides A N , Szendro G , Irvine A , Lewis R , Malouf G M , Hobbs J T , Dudley H A F 
Published: March 2007

Abstract
A total of 149 consecutive unselected patients (221 limbs) who presented with signs and symptoms of chronic venous problems (varicose veins with or without ankle oedema, skin changes and leg ulcers) have been studied by clinical examination, ascending deep to superficial venography, Doppler ultrasound and ambulatory venous pressure measurements. Of the limbs, 180 (82 per cent) had varicose veins without obstruction in the deep veins or reflux in the popliteal or femoral veins while 41 (18 per cent) had deep venous disease. Of the 180 limbs with ‘primary’ varicose veins 110 (60 per cent) did not have incompetent calf perforating veins (group A) while 70 (40 per cent) did (group B). On the basis of the ambulatory venous pressure after calf muscle exercise and the refilling time, the incompetent calf perforating veins of limbs in group B belonged to three subgroups of different haemodynamic significance. In 20 limbs (30 per cent) they were found to be of no haemodynamic significance, in 25 (35 per cent) of moderate haemodynamic significance and in 25 (35 per cent) of major haemodynamic significance. The last were, on clinical examination, indistinguishable from limbs with deep venous disease although they had patent deep veins with competent popliteal valves.
Influence of local recurrence on survival: A controversy reviewed from the perspective of soft tissue sarcoma
Authors: Barr L C , Stotter A T , A'Hern R P 
Published: March 2007

Abstract
The relationship between local recurrence and survival has been examined using the example of soft tissue sarcomas of the extremities. Studies that appear to indicate that local recurrence does not jeopardize survival are shown to have been inappropriately analysed, to have inadequate patient numbers, or both. A survival deficit due to local tumour recurrence cannot be excluded on present data, and clinical decisions regarding conservative versus radical surgery will therefore continue to involve an element of value judgement.
Autologous transfusion: An alternative to transfusion with banked blood during surgery for cancer
Authors: Miller G V , Ramsden C W , Primrose J N 
Published: March 2007

Abstract
Autologous blood transfusion in surgery for cancer has been avoided because of the metastatic potential of reinfused malignant cells. This study determined whether viable tumour cells remain in the red cell concentrate after separation and whether blood transfusion filters remove these tumour cells before reinfusion. Units of banked blood were inoculated with tumour cell lines: breast cancer SKBr3; colon cancer COLO 320; lymphoma Daudi; erythroleukaemia K562. After processing with the Cell Saver®, aliquots of the red cell concentrate and waste saline wash were examined for tumour cells and cultured. Tumour cells from all four cell lines were identified in the red cell concentrate but not in the waste saline wash. All the cell lines except Daudi grew from the red cell concentrate. Experiments on two of the cell lines (SKBr3 and COLO 320) were performed in which the red cell concentrate was either unfiltered (control) or filtered with SQ40S blood transfusion filter or RC100 leucocyte depletion filter. Both cell lines were present in the control samples and after filtration with SQ40S filters, and cells from these samples grew normally in culture. No tumour cells were evident after filtration with the RC100 filters and no growth of either cell line was found after 1 week in culture. The Cell Saver in combination with RC100 filters may be suitable for use during the surgical treatment of malignant disease.
Paget's disease of the nipple
Authors: Dixon A R , Galea M H , Ellis I O , Elston C W , Blamey R W 
Published: March 2007

Abstract
A total of 48 women with Paget's disease of the nipple (nipple eczema containing Paget cells but without a palpable lump) presented to one surgeon over a 13-year period. Temporary healing of the nipple eczema occurred in six patients. In all, 21 of 34 patients with in situ (DCIS) or invasive ductal carcinoma had mammographic abnormalities. Treatment was by simple mastectomy (37 cases), cone excision of the nipple-areola complex (ten cases) and tamoxifen (one case). DCIS was found in 45 operative specimens (96 per cent); eight had associated invasion. The DCIS was predominantly large cell solid/comedo in type and was multifocal in seven cases (19 per cent). At a median (range) follow-up of 56 (18–96) months, four of the ten patients treated by cone excision have developed a local recurrence, two of these patients have also developed metastases. Two of the 37 patients who underwent mastectomy developed loco-regional recurrences; both had invasive foci at their first operation and remain disease free at 8 years. We no longer feel that cone excision is appropriate treatment.
Deep vein thrombosis: Effect of graduated compression stockings on distension of the deep veins of the calf
Authors: Smith Coleridge , Hasty J H , Scurr J H 
Published: March 2007

Abstract
The mechanisms by which graduated compression stockings prevent deep vein thrombosis are not completely understood. Recent work has suggested that venous distension plays a role in initiating the process. Our previous work has shown that the deep veins of the lower limb distend in patients undergoing surgical procedures. We have investigated 40 patients receiving surgical treatment on the abdomen or neck. A medial gastrocnemius vein was studied using ultrasound imaging during the operations. In half the patients a graduated compression anti-embolism stocking was applied to the limb under study at the start of the operation, immediately after initial measurements of vein diameter. The median vein diameter in both groups was the same at the start of the operative procedures (control, 2·6 mm, interquartile range 2·1–3·3 mm; stocking, 2·6 mm, interquartile range 2·1–3·7 mm). After application of a stocking the median diameter in this group fell to 1·6 mm (interquartile range 1·3–2·8 mm) and then decreased slightly at the end of the operation. In the control group the vein diameter increased to 2·9 mm (interquartile range 2·3–4·0 mm) during the operative procedure.
Improving survival in gastric cancer: Review of operative mortality in english language publications from 1970
Authors: Macintyre I M C , Akoh J A 
Published: March 2007

Abstract
In this review of English language publications from 1970, operative mortality following surgery for gastric cancer has been analysed. Operative mortality has declined in series reporting operations in successive decades to 1970, 1980 and 1990. Series reporting patients having surgery for gastric cancer in the decade to 1990 show a mean operative mortality rate of 7·8 per cent (median 4·6 per cent). This improvement may have contributed to the declining mortality rates for gastric cancer in the face of unchanging surgical workload. Results of operations for gastric cancer should be reported in a standard manner.
Extracorporeal shock wave treatment of common bile duct stones: Experience with two different lithotriptors at a single institution
Authors: Den Toom R , Nijs H G T , van Blankenstein M , Laméris J S , Schröder F H , Terpstra T 
Published: March 2007

Abstract
Extracorporeal shock wave lithotripsy (ESWL) is a new treatment modality for retained common bile duct stones. Sixty-two patients (mean age 75 years, range 27·95 years) with retained common bile duct stones were treated with two different lithotriptors. One of the lithotriptors operated on the electrohydraulic principle (Dornier HM-3) (n = 13), the other on the electromagnetic principle (Siemens Lithostar®) (n = 49). All HM-3 patients were treated under general anaesthesia, whereas with the Lithostar one patient was treated under general anaesthesia, 43 received analgesia and sedation and five had no analgesia at all. Patients treated with the Lithostar had more sessions (mean 1·9 versus 1·3, P&lt;0·05) and needed more shock waves (mean 8611 versus 2534, P&lt;0·001) than patients treated with the HM-3. Fragmentation was achieved in all patients treated wih the HM-3 and in 42 (86 per cent) patients treated with the Lithostar. In this latter group ten patients underwent common bile duct exploration without complications. Eleven patients had transient haematuria after treatment with the HM-3 and two patients (one in each group) had a subcapsular haematoma of the right kidney, all without clinical sequelae. At follow-up (median: HM-3 43 months, Lithostar 18 months), none of the patients had biliary complaints. We conclude that ESWL of retained common bile duct stones is safe and effective with both lithotriptors and should be considered before surgery in the elderly or high-risk patient.
Results of surgery for duodenal ulcer: Assessment by patients
Authors: Stanton P D , Anderson J R 
Published: March 2007

Abstract
A questionnaire was administered to 224 patients who had undergone 246 operations for duodenal ulcer to see how well this correlated with Visick grading and to provide insight into the patients' feelings about the results of their surgery. The patients were divided into three groups by Visick grade: good (grade I, n = 70), satisfactory (grades II and IIIs, n = 104) and poor (grades IIIu and IV, n = 72). The distribution of questionnaire responses in each group was statistically different (P &lt; 0·01). Dividing the questionnaire responses into three corresponding groups, 72 per cent of patients assigned themselves to the same group as their Visick grade. Three observations were made regarding the Visick system: recurrent ulceration is over-scored and should be included only if symptomatic; grading should acknowledge a wider range of symptoms related to ulcer disease and its treatment; only three grades are necessary.
Clinical significance of the large adrenal mass
Authors: Khafagi F A , Gross M D , Shapiro B , Glazer G M , Francis I , Thompson N W 
Published: March 2007

Abstract
Current clinical teaching indicates that large (&gt;5 cm in diameter) adrenal masses are often malignant. In a retrospective analysis of patients studied between 1977 and 1988 with computed tomography (CT), adrenal scintigraphy, and when available, magnetic resonance imaging (MRI) 45 were found to have adrenal masses greater than 5 cm (range 5–19 cm) in diameter. Thirty were benign (16 phaeochromocytomas, six adrenocortical adenomas, four adrenal cysts, two myelolipomas, an adrenal hematoma and a ganglioneuroma). Of 15 malignant masses, there were seven adrenocortical carcinomas, five adrenal metastases and three adrenal lymphomas. With the exception of the adrenal myelolipomas, cysts, and the ganglioneuroma neither CT nor MRI demonstrated sufficient diagnostic specificity to distinguish benign from malignant lesions. Functional scintigraphy with 131I-6-β-iodomethyl-19-norcholesterol for suspected adrenocortical lesions and 131I-metaiodobenzylguanidine for suspected phaeochromocytomas frequently provided useful information.
Time trends in incidence rates of acute, non-traumatic extremity ischaemia: A population-based study during a 19-year period
Authors: Ljungman C , Adami H-O , Bergqvist D , Berglund A , Persson I 
Published: March 2007

Abstract
Time trends in the occurrence of acute limb ischaemia were studied from 1965 to 1983 in a defined geographical area in Sweden. Data were obtained from a computerized register which covers all instances of inpatient care for a population of 1·3 million. Analysis based on 5394 first admissions for acute arterial occlusion revealed that the annual number increased by 2·7 per cent yearly in women and 3·9 per cent in men whereas the age-adjusted incidence remained stable for women and increased by 2·6 per cent yearly for men. A study of 1189 patients who underwent surgical procedures showed that the annual number of embolectomy procedures increased 7·6 per cent for females and 8·6 per cent for males. The corresponding age-adjusted incidence rose annually by 3·0 per cent for women and by 7·5 per cent for men. The introduction of the Fogarty catheter and an increasing interest in vascular sugery may have contributed to the increasing rates of operations during the period of study.
Effects of two methods of endothelial cell seeding on cell retention during blood flow
Authors: Budd J S , Allen K E , Bell P R F 
Published: March 2007

Abstract
The potential benefits of endothelial cell seeding depend not only on effective cell attachment, but also on the ability of the cells to resist the stresses of blood flow. We have investigated the effect of different blood flow rates on immediately seeded grafts (SHORT) and also on preformed confluent monolayers formed by overnight incubation (LONG). Cells were labelled with indium and then exposed to either 100 or 200 ml/min of pulsatile blood flow. Cell retention was measured up to 120 min. At both flow rates the LONG seeding procedure gave significantly better cell retention than the SHORT method (P&lt;0·01 at all times). There was no difference in cell retention between the two flow rates in the LONG group, but more cells detached at the higher flow rate in the SHORT group (P&lt;0·01). We conclude that the new seeding method, using preformed confluent monolayers, significantly improves cell retention during blood flow.
Therapeutic aspects of radio-isotopes in hepatobiliary malignancy
Authors: Novell J R , Hilson A , Hobbs K E F 
Published: March 2007

Abstract
Liver tumours frequently present at a late stage and only a minority of patients are likely to benefit from resection or transplantation. Inoperable tumours carry a grave prognosis. External beam irradiation of the liver is dose-limited by the radiosensitivity of hepatocytes, particularly in the presence of cirrhosis, but internal radiation using radio-isotope sources can achieve more selective irradiation of the chosen field. Sealed sources are dose-limited by their effects on surrounding tissues, whereas with unsealed sources the dose of radio-isotope administered is limited by bone marrow suppression. Iridium-192 wires are most frequently employed as a sealed intracavitary source. They may be inserted surgically, transhepatically or endoscopically. Doses of up to 60 Gy can be delivered to a malignant biliary stricture without damage to the surrounding parenchyma. The incidence of cholangitis is low if treatment is administered after insertion of an endoprosthesis. Unsealed radio-isotope sources may be injected directly into the tumour, administered embolically via the hepatic artery in the form of microspheres or lipid droplets, or given via parenteral infusion attached to tumour-specific antibodies. Of these vehicles, the lipid agent Lipiodol appears to be the most effective and can deliver a potentially lethal dose of radiation to small tumours. Host reaction to the injected antibody remains a major drawback to the use of monoclonal antibodies as targeting agents. Iodine-131 is a β and γ emitter, producing a local tumoricidal effect and allowing accurate dosimetry by means of external scintigraphy. Yttrium-90 is a pure β emitter with a greater maximum β energy and cytotoxic range; however, it is retained in bony tissues, resulting in a dose-related risk of marrow suppression. Bone absorption cannot be measured by external imaging owing to the absence of γ emission. This lack of accurate dosimetry, coupled with the toxic side-effects of yttrium treatment, make iodine-131 the current isotope of choice.
Clinical and functional results of abdominal rectopexy for complete rectal prolapse
Authors: McCue J L , Thomson J P S 
Published: March 2007

Abstract
Between 1977 and 1987, 53 patients underwent polyvinyl alcohol sponge rectopexy for complete rectal prolapse. The mean follow-up period was 36·7 months. Full thickness prolapse recurred in two patients (3.8 per cent). Infection around the prosthesis and faecal impaction developed in two patients each. Continence improved significantly after operation, particularly in those under 70 years of age (P = 0·028, ξ2 test) and nulliparous women (P = 0·026, ξ2 test). Bowel function was generally unchanged after rectopexy; in particular only eight patients (15 per cent) had significant postoperative constipation.
Emergency laparotomy in patients with AIDS
Authors: Davidson T , Allen-Mersh T G , Miles A J G , Wastell C , Gazzard B , Vipond M , Stotter A , Miller R F , Fieldman N R , Slack W W 
Published: March 2007

Abstract
The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.