bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physiological and histochemical adaptation of the electrically stimulated gracilis muscle to neoanal sphincter function
Authors: George B D , Williams N S , Patel J , Swash M , Watkins E S 
Published: March 2007

Abstract
The physiological and histochemical characteristics of the gracilis muscle were studied in 19 patients undergoing electrically stimulated gracilis neosphincter construction. Indications for surgery were faecal incontinence (n = 11) and reconstruction following sphincter excision or congenital absence (n = 8). Transposition of the gracilis muscle around the anal canal followed by chronic low-frequency electrical stimulation was associated with a shift in the frequency-response curve and a prolongation of the time-course of individual muscle twitches suggestive of transformation to a slow-twitch fatigue-resistant type. Temporary cessation of electrical stimulation resulted in a reversal of the frequency-response changes. Muscle biopsies taken before and a median of 80 (range 49–137) days after transposition and low-frequency electrical stimulation indicated a significant increase in the proportion of type 1 fibres and a significant decrease in their diameter. These results show that the human gracilis muscle is capable of physiological and histochemical adaptation to long-term neosphincter function.
Eye protection for the vascular surgeon
Authors: Berridge D C , Lees T A , Chamberlain J , Jones N A G 
Published: March 2007

Abstract
Contamination occurring during vascular surgery was studied prospectively using a surgical mask incorporating a Splashguard visor. Over a 16-week period 78 vascular procedures were included; 44 were of &lt; 2 h duration and 34 were of ⩾ 2 h. Contamination on both mask and visor from blood spots was recorded at the end of each procedure. Overall, 51 per cent of principal surgeons' visors were contaminated, with contamination of the mask itself in 32 per cent. When two surgeons were operating the contamination rate for the second was also high: 36 per cent for the visor and 42 per cent for the mask. Assistants had a contamination rate of 36 per cent for the visor and 13 per cent for the mask. The lowest rate of contamination occurred for the visor and mask of the scrub nurse, 10 and 4 per cent respectively. For emergency procedures the duration of operation had no influence on the frequency of contamination. However, for the principal surgeon elective operations of &lt; 2 h duration were less likely to involve contamination than those of ⩾ 2 h (P &lt;0·035). Blood contamination of visors and masks is common in vascular surgery but rarely appreciated by the surgeon. Routine eye protection should be considered in vascular surgery, in particular for emergency and prolonged elective procedures.
Genetic linkage analysis applied to unaffected women from families with breast cancer can discriminate high- from low-risk individuals
Authors: Porter D E , Steel C M , Cohen B B , Wallace M R , Carothers A , Chetty U , Carter D C 
Published: March 2007

Abstract
Up to 20 per cent of cases of breast cancer diagnosed in women under the age of 45 years may be caused by an autosomal dominant gene. A present difficulty is differentiation of mutation carriers from nonmutation carriers in high-risk families. Genetic linkage analysis has been used to localize a susceptibility gene (BRCA1) on chromosome 17q12-21 between markers 42D6 and MFD 188, a region 5–10 million base pairs in length. Odds in favour of linkage to this region were greater than 100 000: 1 in 15 families with breast cancer. In eight families in which the probability of linkage was above 75 (range 79·2–99·9) per cent, 19 women were identified who were at high lifetime risk of breast cancer (range 80·6–87·2 per cent) and 37 whose risk was similar to that for the general population (range 9·8–16·4 per cent). Genetic risk prediction of this kind may enable high-risk screening clinic resources to be concentrated on those most likely to benefit.
Prospective comparison of laparoscopic and conventional anterior resection
Authors: Tate J J T , Kwok S , Dawson J W , Lau W Y , Li A K C 
Published: March 2007

Abstract
A prospective comparison of laparoscopically assisted (n = 11) and conventional (n = 14) anterior resection in patients with sigmoid colon or upper rectal cancer was carried out. Patients were not randomized: age and the presence of metastases determined the type of surgery. Laparoscopic assistance was used to mobilize the tumour and minimize the abdominal incision. This was achieved in all patients and six of the 11 required only a muscle-splitting incision. The mean(s.d.) operating time was longer for laparoscopic than conventional surgery (205(31) versus 123(26) min, P = 0.01). The mean(s.d.) time to reintroduction of normal diet (2.5(0.2) versus 3.6(0.3) days, P = 0.01), postoperative analgesia requirement (2.6(0.4) versus 7.4(2.1) doses of pethidine, P = 0.01) and length of hospital stay (12.3(3) versus 14.3(6) days, P = 0.08) were less in the laparoscopic group. Histopathological examination of the resection specimens showed similar results for the two procedures. Major complications were few and occurred in a similar proportion of patients treated laparoscopically or conventionally. Laparoscopically assisted anterior resection is technically feasible, adequate tumour excision can be achieved and recovery after operation is enhanced.
Resection-line involvement in gastric cancer: A continuing problem
Authors: Hallissey M T , Jewkes A J , Dunn J A , Ward L , Fielding J W L 
Published: March 2007

Abstract
Surgeons are aware of the adverse effect that resection-line disease has on anastomotic leakage, perioperative mortality and long-term survival. In an attempt to assess the effect of this knowledge on surgical practice, patients entered into the second British Stomach Cancer Group adjuvant therapy trial were studied. The presence of resection-line disease was compared with the operative stage. Of 555 patients for whom complete data were available, resection-line disease was present in 105 (19 per cent). Of 424 patients undergoing what the surgeon considered to be a potentially curative operation, 55 (13 per cent) had involvement of one or both resection lines, rendering the surgery palliative. Only 9 per cent of patients with stage I–III disease and resection-line involvement survived beyond 5 years, compared with 27 per cent of those with clear lines. Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation.
Vertical banded gastroplasty for the treatment of morbid obesity
Authors: Ashley S , Bird D L , Sugden G , Royston C M S 
Published: March 2007

Abstract
Prospective evaluation of 114 obese patients (96 women, 18 men) undergoing vertical banded gastroplasty over a 5-year period was undertaken. The age range was 17–58 (median 37) years, median weight 119·3 (range 79–216) kg, mean(s.d.) proportion of excess body-weight 104·1(34·9) per cent and median body mass index (BMI) 44·8 (range 33·2–77·7) kg/m2. Three gastric outlet stoma circumferences were used: 5·5 cm (31 patients), 5·0 cm (28) and 4·75 cm (55). A total of 109 patients (95·6 per cent) were available for follow-up. At 1 year after operation, 54 patients (59 per cent) had lost greater than 50 per cent of excess body-weight. No patient lost less than 25 per cent of excess body-weight, and the median BMI was 32·5 (range 21·3–47·8) kg/m2. The operative mortality rate was zero, but three patients (2·6 per cent) with gastric leakage required surgical revision. Vertical banded gastroplasty is a relatively safe and simple procedure that produces significant and sustained weight reduction in the majority of morbidly obese patients.
Reoperation for biliary tract complications following orthotopic liver transplantation
Authors: Ramirez P , Parrilla P , Bueno F S , Robles R , Pons J A , Acosta F 
Published: March 2007

Abstract
Biliary tract complications were analysed after 54 orthotopic liver transplantations performed in 49 patients over a 2-year period. Reconstruction of the bile duct consisted of end-to-end choledochocholedochostomy over a T tube in 47 cases and Roux-en-Y choledochojejunostomy in seven (two for sclerosing cholangitis, one for secondary biliary cirrhosis, four retransplants). The T tube was withdrawn 12–16 weeks after operation in all but two patients (2–3 weeks). There was no intraoperative mortality. Eight patients (16 per cent) died during the first month and the 1-year actuarial survival rate was 75 per cent. Early biliary complications (up to 3 months after operation) consisted of five bilomas, for which ultrasonographically guided drainage was effective in three and surgical drainage necessary in two. Late biliary complications (3 months onwards) consisted of biliary peritonitis following T tube removal (four patients; reoperation was required in all four) and necrosis of the bile duct secondary to a late arterial thrombosis (one). The incidence of reoperation as a result of early biliary complications was low (two patients), but higher for biliary peritonitis following T tube removal.
Mucosal morphology, cell proliferation and faecal bacteriology in acute pouchitis
Authors: Kmiot W A , Youngs D , Tudor R , Thompson H , Keighley M R B 
Published: March 2007

Abstract
A study was performed to investigate whether acute reservoir ileitis (pouchitis) is associated with specific changes in mucosal morphology, crypt cell kinetics and faecal bacteriology in the ileal pouch. Forty-six patients were studied (ileal reservoir, 36; end ileostomy, ten) using clinical grading, sigmoidoscopy and biopsy; 24 patients with a reservoir were restudied after therapy for 1 month with metronidazole 400 mg three times daily. An index of villus atrophy and crypt cell production rate (CCPR) were determined in all biopsy material. Faecal bacteriology was assessed in 12 patients with a pouch before and after metronidazole therapy. The mucosa of patients with pouchitis was associated with a lower villus atrophy index (P = 0·052), a higher CCPR (P = 0·03) and a higher grade of acute inflammation than that in those without pouchitis. There was no difference in faecal bacterial counts between patients with and without pouchitis. A low atrophy index correlated with a high CCPR (P &lt; 0·001), worse functional score (P &lt; 0·001) and more severe pouch mucosal acute inflammation (P &lt; 0·001), but not with faecal bacteriology. Following metronidazole therapy there was resolution of acute pouch inflammation, increased villus atrophy index (P = 0·049), decreased CCPR (P = 0·049) but no differences in faecal bacterial counts apart from Bacteroides species. These data show that metronidazole therapy does not specifically alter the growth of common faecal bacteria in patients with pouchitis, apart from Bacteroides species. However, metronidazole causes resolution of the typical changes in pouch mucosal morphology and crypt cell kinetics associated with pouchitis.
Popliteal aneurysm: Morphology and management
Authors: Ramesh S , Michaels J A , Galland R B 
Published: March 2007

Abstract
Since January 1988, 32 patients have presented with 44 popliteal aneurysms (22 thrombosed, 22 non-thrombosed). Patients with thrombosed aneurysms were older (median age 72 versus 66 years), and more likely to have bilateral lesions (P &lt; 0·02) and serious associated cardiovascular disease (P &lt; 0·02). Nineteen aneurysms thrombosed acutely; 12 were treated with intra-arterial thrombolysis, which was at least partially successful in seven. All 12 were subsequently bypassed, as were the other seven which were associated with such severe ischaemia that they required urgent operation. One patient died and two others required major amputation. Other complications included foot-drop (two patients), renal failure (one) and wound infection (two). Two grafts thrombosed and required re-exploration. Elective bypass was carried out in 11 patients without acutely thrombosed aneurysms; there were no significant postoperative problems. Distortion within the aneurysm (P &lt; 0·01), large size (P &lt; 0·01) and distortion of the popliteal artery above or below the lesion (P &lt; 0·02) were all associated with thrombosis. Stenosis within the aneurysm was more likely in patients with multiple lesions (P &lt; 0·01) and distortion with larger aneurysms (P &lt; 0·01). After correcting for distortion, none of the other variables was independently significant. The combination of distortion and diameter &gt; 3 cm was present in 13 of 15 thrombosed aneurysms. Morbidity is high following acute thrombosis of popliteal aneurysm. Distortion of the aneurysm appears to be a more sensitive predictor of thrombosis than size alone. The combination of distortion with a diameter &gt; 3 cm may help to define popliteal aneurysms that should be bypassed electively.
Physical examination and selective conservative management in patients with penetrating injuries of the neck
Authors: Demetriades D , Charalambides D , Lakhoo M 
Published: March 2007

Abstract
This prospective study of 335 patients with penetrating injuries of the neck examined the decision whether to operate or observe according to a protocol based mainly on physical examination. Emergency angiography was performed in only three patients. Sixty-six patients (20 per cent) were subjected to emergency operation because of signs and symptoms suggestive of significant injury (60 patients) or because of positive investigations (six). The remaining 269 patients (80 per cent) were selected for non-operative management. Two of these patients (0·7 per cent) required elective operation during the initial hospital stay. No deaths occurred in patients treated conservatively. Some 192 (72 per cent) of observed patients were available for early follow-up and 111 (42 per cent) for late follow-up. No significant complications were found. Physical examination is a reliable method for detecting significant injuries following penetrating neck trauma. Emergency angiography is rarely necessary.
Timing of extubation after oesophagectomy
Authors: Caldwell M T P , Murphy P G , Page R , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
Ventilatory support for 24 h after surgery is standard practice in many units after oesophagectomy, especially for patients in whom respiratory problems are anticipated. Weaning difficulties may occur, however, and there is increasing evidence that mechanical ventilation is associated with alveolar trauma. A deliberate change in policy was instituted in the authors' unit in January 1990 to make early extubation mandatory in all patients undergoing elective oesophagectomy, apart from those in whom serious perioperative problems were encountered. The present study compared two sets of patients: group 1 (n = 36) underwent oesophagectomy in the year before the policy change and group 2 (n = 45) oesophagectomy in the year after. The two groups were similar in age, sex and respiratory risk factors. Early extubation was carried out in 38 patients in group 2 compared with eight in group 1 (P &lt; 0·001). Only two patients in group 2 required prolonged ventilation compared with ten in group 1 (P &lt; 0·005). No patient in group 2 required reventilation compared with seven in group 1 (P &lt; 0·005), and no patient in group 2 who had undergone early extubation required delayed ventilation. The mean ventilation time and length of stay in the intensive care unit were significantly reduced following the policy change. Early extubation after elective oesophagectomy is an attainable goal and results in a significant reduction in both the morbidity rate and cost of surgery.
Granulocyte—macrophage colony-stimulating factor inhibits tumour growth
Authors: Hill A D K , Redmond H P , Austin O M , Grace P A , Bouchier-Hayes D 
Published: March 2007

Abstract
The effect of granulocyte—macrophage colony-stimulating factor (GM—CSF) on murine antitumour responses was examined. Sixty mice received Lewis lung carcinoma implants and were then randomized to receive GM—CSF 1 μg/day, GM—CSF 0·5 μg/day or saline for 10 days and studied with regard to tumour volume, carcass weight and food intake. Macrophage antitumour mechanisms including oxygen free radical production and nitric oxide release were studied in peritoneal macrophages after co-culture with GM—CSF in vitro and in vivo. GM—CSF 1 μg/day decreased tumour growth after 5 days (mean(s.e.m.) 0·62(0·4) versus 1·24(0·19) cm3, P = 0·017). GM—CSF upregulated macrophage antitumour mechanisms by enhancing the in vivo production of superoxide radicals (mean(s.e.m.) 0·69(0·06) versus 0·45(0·10) nmol, P &lt; 0·05) and nitric oxide (mean(s.e.m.) 48(3) versus 24(4) μmol, P &lt; 0·01). GM—CSF functions through the enhancement of macrophage tumoricidal activity, suggesting a therapeutic potential for this cytokine in the tumour-bearing host.
Pancreatic necrosis: Assessment of outcome related to quality of life and cost of management
Authors: Fenton-Lee D , Imrie C W 
Published: March 2007

Abstract
Ten patients with necrotizing pancreatitis admitted consecutively between August 1990 and August 1991 were studied. They comprised eight men and two women of median age 63 (range 29–73) years. One patient died. The median length of hospital stay was 74 (range 40–150) days. The median number of operations and endoscopic procedures performed per patient was 4 (range 2–7). Investigations performed included multiple bacteriological, radiological, haematological and biochemical tests. The mean cost of management was £18 441 (range £9296–£33 796), of which hospitalization accounted for 65 per cent, operations and endoscopic procedures 20 per cent and investigations 16 per cent. Cost—utility analysis demonstrated a mean benefit per patient of 8·55 quality-adjusted life years gained at a cost of £2157 each. The management of pancreatic necrosis is expensive but justified by the excellent outcome in terms of quality of life.
Good long-term results in patients surviving severe acute pancreatitis
Authors: Doepel M , Eriksson J , Halme L , Kumpulainen T , Höckerstedt K 
Published: March 2007

Abstract
Thirty-seven patients treated for severe acute pancreatitis were investigated a mean of 6·2 years after the attack; 30 were found to be in good condition and 24 were working normally. Two-thirds of previously heavy drinkers had either reduced their intake considerably or become abstainers. The main complication observed on follow-up was diabetes mellitus, which affected 20 patients and required insulin treatment in nine. Of the remaining patients, four were taking oral antidiabetic agents and seven were on a strict diabetic diet. Before severe acute pancreatitis none had been diabetic. All patients who underwent resection of the pancreas developed diabetes. In 21 of 24 patients with overt or imminent diabetes, pancreatitis had been primarily alcoholic in origin. Polyneuropathy, as diagnosed by clinical signs and/or neurophysiological tests, was observed in six patients, all of them heavy drinkers. It is concluded that patients with severe acute pancreatitis have a high chance of returning to normal activity and productive work. These results serve to encourage all those involved to persist with the exacting work involved in treating such patients.
Early discharge after operation
Authors: Narayan A , Kumar S , Singh M P , Sharma L K 
Published: March 2007

Abstract
To assess the feasibility and advantages of short-stay surgery in India, a policy of early discharge was adopted for 386 patients undergoing various major and minor operations. The mean postoperative and total hospital stays of patients admitted for minor surgery were 1·9 and 3·7 days respectively; the corresponding figures for age- and sex-matched historical controls were 7·4 and 11·3 days. The mean postoperative and total stays of patients who had undergone major surgery were 4·1 and 8·0 days respectively; the corresponding control values were 8·9 and 12·5 days. The use of absorbable subcuticular skin sutures helped to shorten postoperative hospital stay and avoided an extra follow-up visit. The overall complication rate in the study group was 9·6 per cent and in historical controls 13·4 per cent (P &gt; 0·05). A total of 2357 hospital bed-days were saved during the study and 95·6 per cent of patients approved of short-stay surgery.
Surgical management of perineal and metastatic cutaneous Crohn's disease
Authors: Williams N , Scott N A , Watson J S , Irving M H 
Published: March 2007

Abstract
Skin lesions are the commonest extraintestinal manifestation of Crohn's disease. Lesions that develop at sites remote from the gastrointestinal tract and have granulomas on histological examination are termed metastatic cutaneous Crohn's disease. Management is difficult as medical treatment is often ineffective. This report describes the use of surgical debridement of areas of perineal metastatic cutaneous Crohn's disease in five patients, all of whom had failed to improve after a variety of medical treatments. One patient had a poor result with continuing mild perineal discharge and four had a good outcome with complete resolution of symptoms and satisfactory cosmetic results.
Laparoscopic colorectal surgery: A prospective assessment and current perspective
Authors: Wexner S D , Cohen S M , Johansen O B , Nogueras J J , Jagelman D G 
Published: March 2007

Abstract
Between August 1991 and June 1993, 74 laparoscopic and laparoscopically assisted colonic and rectal operations were performed. A variety of procedures were carried out including 32 total abdominal colectomies (group 1), 32 segmental resections (group 2) and ten constructions of a diverting stoma without formal resection (group 3). Indications for surgery were mucosal ulcerative colitis in 20 patients, carcinoma in 12, polyposis in six, Crohn's disease in seven and other conditions in the remaining 29. The 74 comprised 42 male and 32 female patients of mean age 45 (range 12–88) years. The median (range) duration of the procedure was 3·0 (1·0–6·5) h for the entire group, 3·9 (2·5–6·5) h for group 1, 2·9 (1·5–5·5) h for group 2 and 1·8 (1·0–2·5) h for group 3. The median (range) length of ileus was 3·0 (2–7) days overall; respective times for groups 1–3 were 3·5 (2–7), 3·0 (2–7) and 2·0 (1–4) days. The median (range) length of hospitalization was 7·0 (2–40) days, 8·1 (4–19) days in group 1, 7·0 (4–20) days in group 2 and 6·0 (2–40) days in group 3. Ten patients (14 per cent) developed intraoperative and 15 (20 per cent) postoperative complications; there were no deaths. These results failed to confirm any significant advantages of laparoscopic or laparoscopically assisted colorectal surgery. Specifically, neither the operating time, nor length of ileus, nor length of hospitalization was improved over standard procedures. Advances in technology and surgical technique may improve such findings in the future.
New technique for sigmoid colectomy
Authors: Lirici M M , Bueß G , Melzer A , Weinreich S , Wehrmann M , Becker H D 
Published: March 2007

Abstract
A combination of laparoscopic and rectoscopic procedures has enabled complete resection of the sigmoid colon and eliminated the need for minilaparotomy when constructing the anastomosis or withdrawing the specimen. This combined procedure was performed in different ways in a series of animal models until the definitive technique had been standardized. These techniques were then successfully used in 15 consecutive medium-sized pigs. Histological evaluation of the specimens, including the anastomosis (examined 2–3 weeks after operation) confirmed the efficacy and safety of the method.