bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double-blind randomized trial of perioperative fibrinolytic enhancement for femoropopliteal bypass
Authors: Berridge D C , Frier M , Westby J C , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Patients with rest pain or acute peripheral arterial thrombosis are known to have impaired endogenous fibrinolysis, which is associated with an increased risk of early vascular graft thrombosis. This risk is exacerbated by the fibrinolytic shutdown which is known to occur after major surgery. Stanozolol, which has been demonstrated to enhance endogenous fibrinolysis, was therefore used in an attempt to prevent this perioperative fibrinolytic shutdown and so enhance graft patency. Twenty-seven patients were randomized to receive either 50 mg stanozolol or placebo intramuscularly 24 h before operation, followed by a 6 week course of either 5 mg stanozolol or placebo orally, twice daily. On the second day after operation, 10–11 MBq of autologous 111indium-labelled platelets were injected, with scanning over the graft on the 3 following days. Despite using a large depot of stanozolol, significant effects, such as raised plasminogen (P &lt; 0·001), reduced fibrinogen (P &lt; 0·001) and reduced euglobulin lysis time (P &lt; 0·001), were not seen until the seventh day after operation, with maximum benefit at 6 weeks. This was reflected in the 111indium-labelled platelet deposition studies. The placebo group had a progressive increase in platelet deposition on all 3 days. In contrast, those receiving stanozolol showed a lower, static picture of deposition. However, these changes did not attain statistical significance. Three patients experienced early graft thrombosis, two in the placebo group and one in the stanozolol group. Only an incomplete inhibition of the perioperative fibrinolytic shutdown was achieved. Much longer preoperative courses are thus required to allow the maximum effect to be present at the most crucial time. At present, perioperative fibrinolytic enhancement does not appear to be a practical proposition, and we must await the development of new safer and more potent agents.
Protein status and metabolic expenditure determine the response to intravenous nutrition - a new classification of surgical malnutrition
Authors: Hill G L , Witney G B , Christie P M , Church J M 
Published: March 2007

Abstract
To determine whether nutritional and metabolic factors affect the response to intravenous nutrition (IVN) 146 surgical patients were classified according to their protein and metabolic status using direct measurements of body protein and metabolic expenditure. The patients were grouped into four categories: category I, moderate to severe protein depletion without raised metabolic expenditure; category II, moderate to severe protein depletion with raised metabolic expenditure; category III, mild protein depletion without raised metabolic expenditure; and category IV, mild protein depletion with raised metabolic expenditure. After 2 weeks of IVN patients in category I gained a mean(s.e.m.) of 0·43(0·06) kg of body protein (P &lt; 0·001) and had significant rises in both plasma transferrin and prealbumin (P &lt; 0·05); patients in category II gained 0·30(0·11) kg of protein (P &lt; 0·005) and also had significant rises in transferrin and prealbumin (P &lt; 0·05). Patients in category III lost 0·24(0·11) kg protein (P &lt; 0·05) and had no changes in either transferrin or prealbumin and patients in category IV lost 0·51(0·13) kg of body protein (P &lt; 0·001) and although there was a significant rise in plasma prealbumin there was no significant change in plasma transferrin. When postoperative patients were examined separately, they did not differ significantly from preoperative patients except in category I, where their protein gain was only 0·19(0·10) kg, an amount not significantly different from that gained by patients in category II. In each of the four categories described, the changes in total body protein occurring with 2 weeks of IVN were determined by the relative effects of two competing processes; protein depletion and raised metabolic expenditure. With moderate to severe protein depletion (approximately 30 per cent depletion of body protein stores) there was a marked tendency to gain protein with IVN. When the patient had a raised metabolic expenditure or was postoperative this tendency of depleted patients to gain protein was still present but it was less. With only mild protein depletion (approximately 10 per cent depletion) increases in metabolic expenditure made it difficult, if not impossible, to prevent continuing protein loss in spite of aggressive nutritional support. The patient categories we have described determine the response to IVN and form the basis of a new clinical classification of surgical malnutrition.
Postoperative hypophosphataemia and muscle function
Authors: Andersen P T , Toft E , Hansen A K , Sinkjaer T 
Published: March 2007

Abstract
Muscle function tests of the triceps brachii muscle were performed before operation and on the third postoperative day in ten patients undergoing elective cholecystectomy. Electromyograms (EMGs) were recorded by surface electrodes during sustained isotonic and isometric muscle contraction with a constant force of 20 per cent of the preoperative maximal voluntary contraction. Root-mean-square of the EMG was calculated together with the neuromuscular efficiency and measures of the fatiguability. These parameters were compared with changes in the simultaneously measured serum phosphate concentrations. Mean(s.e.m.) neuromuscular efficiency measured after 32–40 s of muscle contraction decreased 14(5) per cent after operation (P &lt; 0·01), whereas the mean fatiguability of the muscle was unchanged. Mean serum phosphate concentration was 0·87(0·06) mmol/l before operation and 0·79(0·06) mmol/l 3 days after the operation (P &gt; 0·05). Two patients developed severe postoperative hypophosphataemia (serum phosphate concentration &lt; 0·50 mmol/l). Postoperative muscle function deterioration was not associated with changes in the serum phosphate level (P &gt; 0·10; r = 0·03). We conclude that patients undergoing cholecystectomy develop postoperative deterioration in skeletal muscle function, which is not associated with serum phosphate concentration.
Importance of the omentum in the development of intra-abdominal metastases
Authors: Lawrance R J , Loizidou M , Cooper A J , Alexander P , Taylor I 
Published: March 2007

Abstract
Areas of trauma are preferred sites for metastatic tumour growth. In extensive intra-abdominal tumour recurrence the omentum is invariably involved. The importance of the omentum in the development of tumours at sites of intra-abdominal trauma has been investigated. Colonic anastomoses were performed in Hooded-Lister rats with and without omentectomy. Animals received intraluminal or intraperitoneal injections of a syngeneic tumour. With intraluminal injection, tumour occurred at the anastomosis and in the omentum in 38 and 43 per cent of animals respectively but following omentectomy the values were 14 and 9 per cent (omental remnant). With intraperitoneal administration tumour occurred in 53 per cent at the anastomosis and in 79 per cent in the omentum compared with 16 and 29 per cent (in omental remnant) following omentectomy. In this model a reduced ability of an anastomosis to support ‘seeded’ tumour following removal of the omentum is demonstrated and the development of local recurrence from spilled tumour cells during operation may be enhanced by, or be dependent on, the proximity of the omentum.
Merkel cell tumour: Clinical behaviour and treatment
Authors: Shaw J H F , Rumball E 
Published: March 2007

Abstract
We have reviewed 30 reports of Merkel cell tumour and described a further five cases in order to establish a database and from this more clearly define the biology of this tumour, prognostic factors that govern outcome, and optimal management. After excision alone of the primary lesion, local recurrence occurred in 39 per cent of patients and regional failure occurred in 46 per cent. In contrast, in patients treated by excision plus prophylactic treatment (adjuvant node dissection and/or adjuvant radiation), local recurrence occurred in 26 per cent and regional failure in 22 per cent. Locoregional recurrence carried an ominous significance with 67 per cent of patients subsequently dying of the disease. For patients who either presented with regional disease or later developed regional disease, the best outcome (44 per cent survival with mean follow-up of 40 months) was obtained following treatment by therapeutic node dissection with or without radiation. In contrast, treatment of regional disease with radiation alone was associated with only a 20 per cent survival rate. Unfavourable prognostic factors included young age, lesions sited in the head and neck or trunk, male sex, and the presence of locoregional failure and/or systemic disease. We conclude that Merkel cell tumours behave in a similar manner to the aggressive variants of melanoma and that minimal treatment consists of wide surgical resection of the primary lesion (with a margin of 2.5-3 cm) coupled with resection and probably also radiation of regional disease if present. In addition, consideration should be given to prophylactic node dissection in node negative patients, especially in those patients with unfavourable prognostic factors.
Laparoscopic cholecystectomy: The dundee technique
Authors: Nathanson L K , Shimi S , Cuschieri A 
Published: March 2007

Abstract
A totla of 61 patients was subjected to laparoscopic cholecystectomy. The procedure was completed in 60 cases and converted to open operation in one (2 per cent). The morbidity rate was lot (total 7 per cent, major 2 per cent, blood transfusion rate 5 per cent). The medium duration of the laparoscopic cholecystectomy with cholangiography was 135 min (range 65-270 min). The operation took less time to complete in patients with functioning gallbladders than in those with non-functioning fibrotic organs (median 120 versus 175 min). the majority of patients requried opiate analgesia despite infiltration of the stabh woulds with bupivacaine. The mean(s.d.) hospital stay was 2·9(1·5) days. The median time to resume work or full activity after discharge was 11 days.
Piezoelectric lithotripsy for gallstones: Analysis of results in patients with extended selection
Authors: Darzi A , El-Sayed E , O'Morain C , Tanner W A , Keane F B V 
Published: March 2007

Abstract
Extracorporeal shock wave lithotripsy (ESWL) is successful in fragmenting gallstones, but &lt;28 per cent of patients with gallstone disease fulfil the conventional criteria for treatment. However, no data exist to substantiate these selection criteria. In this study, the selection criteria were broadened to include patients with radiolucent stones of any size and number, and radio-opaque stones &lt;3 cm in diameter. To date, 108 symptomatic patients with gallstones have received treatment. All patients received up to six outpatient sessions of ESWL (6000 shock waves per session) without sedation or analgesia. The dissolution therapy consisted of combined bile salt and terpene administration. The clearance rates were 9 per cent within 2 months, 21 per cent at 2-4 months, 38 per cent at 4-8 months, 60 per cent at 8-12 months, and 78 per cent at 12-18 months. Of patients with a successful outcome only 19 (18 per cent) would have satisfied traditional selection criteria. There have been no significant complications except in one patient who developed mild acute pancreatitis, which settled on conservative treatment, and two patients who developed acute cholecystitis. This study would suggest that the previously accepted selection criteria underestimate the number of patients suitable for gallstone ESWL and dissolution therapy.
Hirschsprung's disease presenting as neonatal gastrointestinal perforation
Authors: Stringer M D , Drake D P 
Published: March 2007

Abstract
In the neonate, Hirschsprung's disease characteristically presents with delayed passage of meconium and/or intestinal obstruction. Intestinal perforation in this age group is more often due to necrotizing enterocolitis or a mechanical obstruction such as atresia or meconium ileus. Hirschsprung's disease, however, may present with intestinal perforation and this association must be recognized promptly if the patients are to be managed appropriately, particularly as half of them have total colonic involvement. Three neonates with Hirschsprung's disease presenting with neonatal intestinal perforation are reported.
Long-term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only
Authors: Horobin J M , Preece P E , Dewar J A , Wood R A B , Cuschieri A 
Published: March 2007

Abstract
One hundred and thirteen women aged 70 years or more with locoregional breast cancer were treated with tamoxifen alone as primary treatment. They were followed for a minimum of 5 years. Complete response occurred in 38 women, partial response in 17, no change in 34 and progressive disease in 24. Where progressive disease occurred, or where patients relapsed after an initial response, the most suitable conventional therapy was given. The actuarial 5-year survival rate was 49·4 per cent for all patients and was much higher (92 per cent) in those showing an initial complete response. Seventy patients (61·9 per cent) were not controlled by tamoxifen alone to death or most recent follow-up. Tamoxifen provides an alternative treatment for operable breast cancer in older women in the short term and may be particularly suitable for those with concurrent disease or who are unwilling to undergo surgery. The low morbidity rate from tamoxifen must be balanced against the need to maintain close follow-up. In the medium to long term, sole primary treatment by tamoxifen delays more definitive therapy.
Abdominal wall tenderness: A useful sign in chronic abdominal pain
Authors: Thomson W H F , Dawes R F H , Carter S S T C 
Published: March 2007

Abstract
The outcome in 72 patients with obscure abdominal pain and a positive Carnett's (abdominal wall tenderness) test, seen in one firm's surgical outpatient clinic between 1975 and 1983, was sought by a combination of hospital note retrieval and general practitioner questionnaire. Full follow-up data to date or death were available for 58 (81 per cent) patients and partial follow-up for 14 patients. The study showed that the patients generated a good deal of investigation and a number of surgical procedures but that seldom were their symptoms attributable to serious pathology. Familiarity with the test, taken in the context of a proper history and examination, has been found helpful in assessing such patients and saves the inconvenience, expense and occasional hazard of investigation, and even surgery.
Cytoreductive surgery in disseminated non-seminomatous germ cell tumours of testis
Authors: Kulkarni R P , Reynolds K W , Newlands E S , Dawson P M , Makey A R , Theodorou N A , Bradley J , Begent R H J , Rustin G J S , Bagshawe K D 
Published: March 2007

Abstract
Between 1977 and 1988, 67 patients underwent surgical removal of residual metastatic deposits following an aggressive chemotherapy regimen (cisplatin, vincristine, methotrexate and bleomycin alternating with etoposide, actinomycin D and cyclophosphamide) for disseminated germ cell tumours of the testis (stage IIB or above). Ninety-one surgical procedures were performed. There were 63 (69 per cent) retroperitoneal lymph node dissections, 16 (18 per cent) thoracotomies, three (3 per cent) hepatic resections, three (3 per cent) craniotomies, five (5 per cent) delayed orchidectomies and one anterolateral decompression of the vertebral column. Nine (13 per cent) patients required a repeat retroperitoneal node dissection and one patient needed a repeat thoracotomy to remove recurrent metastatic deposits during the period of follow-up. Multivisceral resections and vascular reconstruction procedures were required in 20 (30 per cent) patients undergoing retroperitoneal node dissection. Fifty-five (82 per cent) patients remain in complete remission with a mean follow-up period of 49·6 months (range 2–121 months). Nine (13 per cent) patients died with metastatic disease between 2 months to 4 years after operation. There were three deaths in the perioperative period (4 per cent). The histology of the resected metastases revealed undifferentiated active tumour in 20 (30 per cent) patients, differentiated mature teratoma in 29 (43 per cent) patients and fibrosis/necrosis in 18 (27 per cent) patients. Twelve (60 per cent) patients with undifferentiated elements and 15 patients (60 per cent) with raised preoperative tumour markers (poor prognostic categories) are in complete remission. Cytoreductive surgery in patients with metastatic germ cell tumours offers the best chance of remission following chemotherapy even in poor prognostic group categories.
Long-term survival in patients operated on for benign peptic ulcer disease
Authors: Lundegårdh G , Holmberg L , Krusemo U B 
Published: March 2007

Abstract
Survival rate was analysed in a cohort of 6459 patients who had undergone partial gastrectomy for benign ulcer disease and who had survived the first year after operation. The cohort was followed for 27–35 years. There was a slight but significant decrease in relative survival rate to 92 per cent (95 per cent confidence interval 87–97 per cent) 35 years after operation. No decrease in relative survival rate was observed during the first 20 years after operation. There was no difference by gender or surgical procedure, but patients operated on for gastric ulcer, compared with duodenal ulcer, and patients operated on at younger ages had a poorer relative survival rate. The effects of partial gastrectomy on survival, both overall and by diagnosis or age at operation, are probably attributable to confounding factors linked with the peptic ulcer disease rather than to the surgical procedure itself. We conclude that partial gastrectomy seems to have very little impact on survival once the patient has survived the first year after operation.
Effects of cardiac surgery and intraoperative hypothermia on energy expenditure as measured by doubly labelled water
Authors: Taggart D P , McMillan D C , Preston T , Richardson R , Burns H J G , Wheatley D J 
Published: March 2007

Abstract
Total energy expenditure (TEE) was measured over two 10-day periods, before and after operation in 16 patients undergoing coronary artery surgery and randomized to have cardiopulmonary bypass with an intraoperative blood temperature of either 28 or 20°C. TEE was measured with doubly labelled water containing stable isotopes of hydrogen and oxygen to allow calculation of TEE over fixed periods from the differential rate of excretion of the two isotopes. Results were available for eight patients in the 28°C group but for only seven in the 20°C group (one patient in this group was excluded as the temperature allocated was not achieved). The groups were similar with respect to body-weight and lean body mass. The 20°C group received more grafts than the 28°C group, resulting in an increase in cross-clamp and bypass times. Mean preoperative TEE was similar in both groups. The mean difference in fractional turnover rates of hydrogen and oxygen was not significantly different in the postoperative period. There was a non-significant increase in the mean 10-day postoperative TEE, calculated in total calories, of 4·7 per cent in the 28°C and 5·1 per cent in the 20°C group. When changes in postoperative TEE were calculated according to lean body mass, the mean increases were respectively 3·7 and 3·2 per cent. Cardiac surgery utilizing cardiopulmonary bypass and intraoperative hypothermia results in only a modest increase in postoperative TEE. In this study a more profound level of intraoperative hypothermia did not influence the change in postoperative TEE.
Thrombolytic therapy in the management of acute limb ischaemia
Authors: Earnshaw J J 
Published: March 2007

Abstract
Acute limb ischaemia poses a threat to both the limb and life of a patient. Until recently, attempted revascularization by thrombo-embolectomy or vascular reconstruction held the best chance of limb salvage. Thrombolytic techniques afford an alternative method of management for this condition and are effective in selected patients. Low-dose intra-arterial streptokinase is the most established method of thrombolysis, although the recently developed tissue plasminogen activator offers a promising alternative. Intra-arterial thrombolysis is not an easy option, being labour intensive and requiring close co-operation between surgeon and radiologist. Thrombolytic and surgical techniques are not mutually exclusive but are best used to complement each other. Ideally patients with acute limb ischaemia should be managed by surgeons with knowledge of, and access to, optimal current surgical and non-surgical techniques.
Randomized study on the effect of collagen impregnation of knitted Dacron® velour aortoiliac prostheses on blood loss during aortic reconstruction
Authors: De Mol Van Otterloo J C A , van Bockel J H , Ponfoort E D , van den Akker P J , Hermans J , Terpstra J L 
Published: March 2007

Abstract
Intraoperative blood loss is an important factor in reconstructive surgery for aortoiliac disease because it is clearly associated with an increase in the operative morbidity and mortality rates. To minimize intraoperative blood loss, a blood-tight vascular prosthesis has been developed by impregnating a knitted Dacron™ prosthesis with bovine collagen. To study a potential reduction of intraoperative blood loss using these collagen-impregnated prostheses, we conducted a prospective randomized trial involving the collagen-impregnated prosthesis and its non-impregnated substrate, the Dacron knitted non-impregnated prosthesis. During a 2·5-year period, 123 consecutive patients (undergoing 81 procedures for aneurysmal disease and 43 procedures for occlusive disease) were admitted for elective aortic reconstructive surgery. Equal numbers of the two prostheses were randomly implanted. Various parameters were monitored: intraoperative blood loss before aortic cross-clamping (phase 1), during implantation of the prosthesis (phase 2) and after release of aorta cross-clamping (phase 3); the number of intraoperative and postoperative blood transfusions; and, finally, all preoperative and intraoperative factors that might contribute to intraoperative blood loss. A significant overall difference in intraoperative blood loss between the collagen-impregnated (2425 ml) and the non-impregnated (1907 ml) group was found (P = 0·003). However, this difference could not be attributed to collagen impregnation because no statistically significant difference in blood loss was found in the relevant period of operation (phase 3). Similar results were observed in patients operated on for both aneurysmal and occlusive disease (2600 versus 2195 ml and 2105 versus 1344 ml respectively).