bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anorectal function after preoperative intraluminal brachytherapy and colonic J pouch-anal anastomosis for rectal carcinoma
Authors: Kusunoki M , Shoji V , Yanagi H , Kamikonya N , Sakanoue Y , Hishikawa Y , Utsunomiya J 
Published: March 2007

Abstract
The effects of preoperative intraluminal brachytherapy on bowel function after anoabdominal rectal resection and colonic J pouch-anal anastomosis were studied. The patients included eight not receiving irradiation (group 1), eight who received 30 Gy (group 2) and eight who received 80 Gy (group 3). Stool frequency and the incidence of soiling were significantly greater in group 3 than in the other groups. Anal resting pressure was lower in group 3 during the study period but J pouch distensibility was not reduced. The maximum tolerated volume, threshold volume and squeeze pressure were significantly lower in group 3 than in the other groups in the early postoperative period. These results suggest that high-dose brachytherapy affects the anal sphincters and colonic J pouch. A moderate dose of 30 Gy may be more suitable before restorative anorectal surgery.
Risberg retroperitoneal approach to the abdominal aorta
Authors: Butler P E M , Grace P A , Burke P E , Broe P J , Bouchier-Hayes D 
Published: March 2007

Abstract
In a study of the best approach to the infrarenal abdominal aorta, 47 patients were compared retrospectively: 15 underwent a standard transperitoneal incision, 15 a retroperitoneal left flank incision and 17 a new modified lateral pararectus incision, the Risberg approach. Operating time, length of postoperative intubation and hospital stay, mortality rate, morbidity rate and cost were assessed. There was a significant reduction (P &lt;0·05) in mean(s.d.) operating time (141(21) versus 198(41) min), intraoperative cross-clamping time (74(13) versus 104(46) min) and postoperative intubation time (6·5(8·0) versus 13·3(7·3) h) associated with the Risberg retroperitoneal incision compared with the left flank retroperitoneal route. There was also a significant decrease (P &lt;0·02) in mean(s.d.) postoperative intubation time (6·5(8·0) versus 17·5(12·0) h), time after operation to discharge (11·0(2·4) versus 17·3(7·6) days) and hospital cost (£4885(670) versus £7732(580)) associated with the Risberg incision compared with the transperitoneal approach. The Risberg incision gives better access to the infrarenal abdominal aorta while maintaining the advantages of other retroperitoneal approaches. This technique is recommended as the incision of choice for the retroperitoneal approach to the aorta.
Preoperative coagulopathy in ruptured abdominal aortic aneurysm predicts poor outcome
Authors: Davies M J , Murphy W G , Murie J A , Elton R A , Bell K , Gillon J G , McL. Jenkins A , Ruckley C V 
Published: March 2007

Abstract
In a prospective study of 50 consecutive patients undergoing operation for ruptured abdominal aortic aneurysm, a coagulation screen was performed on admission to hospital. Twenty patients with either a platelet count &lt;100 × 109/l or a prothrombin time &gt;1·5 times the control value had a mortality rate of 65 per cent (95 per cent confidence interval 45–85 per cent); a further 23 patients with normal screen results had a mortality rate of 9 per cent (95 per cent confidence interval 0–20 per cent) (P &lt;0·001). Seven patients, of whom three died, did not have an admission coagulation screen performed. Patient age in the study group did not have independent statistical predictive power. This study indicates that coagulopathy at the time of admission predicts poor outcome in patients with ruptured aortic aneurysm. Current management strategies are inadequate for the treatment of these patients, who can be rapidly identified on admission by means of platelet and prothrombin counts.
Computed tomography in the management of blunt abdominal trauma in children
Authors: Turnock R R , Sprigg A , Lloyd D A 
Published: March 2007

Abstract
Sixteen children with suspected abdominal injury were reviewed. All underwent plain abdominal radiography and computed tomography (CT). Fifteen CT scans showed an abnormality, and the abdominal radiograph was abnormal in seven cases. Eight patients also underwent abdominal ultrasonography, and six scans failed to demonstrate an abnormality. Only two patients required laparotomy, one for a ruptured left diaphragm and one for a major renal injury. These results support the use of CT as the optimal method for assessing the stable child following blunt abdominal trauma.
Transatlantic perspectives of trauma systems
Authors: McNicholl B P , Fisher R B , Dearden C H 
Published: March 2007

Abstract
The need for centralized management of acute trauma was evaluated in a 1-year prospective study in Northern Ireland. All patients with an Injury Severity Score &gt;15 who reached hospital alive were included. The sample population was approximately 1 million people. A total of 239 patients entered the study, of whom 74 died. An audit panel considered that 3–15 per cent of deaths were preventable. There was no significant difference in the preventable mortality rate between any hospital or groups of hospitals. There was a high level of consultant involvement, especially in small hospitals. A system in which patients with acute trauma bypass the nearest hospital to reach a trauma centre may be neither beneficial nor cost-effective in Northern Ireland. Upgrading of the present system with stabilization of the patient and emergency surgery at the nearest hospital before transfer is recommended.
Prognostic signs in the evaluation of patients with minor head injury
Authors: Duus B R , Boesen T , Kruse K V , Nielsen K B 
Published: March 2007

Abstract
To assess signs that might be used in the decision whether or not to admit a patient with minor head injury, the records of 713 female and 1163 male patients were reviewed. Skull radiographs were not obtained routinely; all patients were able to walk and talk when they reached medical contact. Nine patients developed an intracranial complication. The risk of developing such a complication was 16·7 per cent when the patient was agitated, 3·4 per cent in the presence of impaired consciousness and 2·1 per cent when positive neurological signs were observed at the time of examination. Based on the medical history, amnesia for &gt;5 min and vomiting were associated with a risk of 3·3 and 1·2 per cent respectively; the risk increased considerably in the presence of both. It is recommended that all patients presenting themselves with one or more of the above symptoms or signs, or with alcohol intoxication, after a minor head injury be admitted for observation. If these guidelines had been used, all patients with an intracranial complication would have been detected, and 44·5 per cent of the bed-days used would have been saved.
Low-dose tumour necrosis factor α and melphalan in hyperthermic isolated limb perfusion
Authors: Hill S , Fawcett W J , Sheldon J , Soni N , Williams T , Thomas J M 
Published: March 2007

Abstract
Nine patients with soft tissue tumours of the lower limb not amenable to treatment other than by isolated limb perfusion or amputation underwent hyperthermic isolated limb perfusion at the level of the superficial femoral vessels, using a combination of recombinant tumour necrosis factor (TNF) α and melphalan. In seven patients with superficial tumours, necrosis and sloughing was apparent within 48 h of perfusion. All patients experienced a complete tumour response. There were no systemic side-effects associated with the use of TNF-α although local side-effects, particularly oedema, were pronounced. Three patients ultimately required amputation because of the large soft tissue defects that resulted from necrosis of the tumour and overlying skin.
Management of malignant melanoma of the head and neck
Authors: Orr D J A , Hughes L E , Horgan K 
Published: March 2007

Abstract
A total of 91 patients with melanoma of the head and neck treated between 1973 and 1991 were studied prospectively with regard to prognostic features, treatment and outcome. Other than Breslow thickness, the only important prognostic feature was the less aggressive nature of lentigo maligna melanoma. A policy of selective excision margins, 1 cm for impalpable and 2 cm for palpable lesions, was found to be safe, although preliminary biopsy should be used if there is diagnostic uncertainty or where the expected extent of surgery entails a mutilating procedure. Local recurrence rates were not affected by the method of wound closure, which should be determined by the best functional and cosmetic outcome. These results support the trend against prophylactic neck dissection. Such dissection, when indicated for lesions of the face, pinna, anterior scalp and parotid area, should routinely include superficial parotidectomy. Uncontrolled symptomatic locoregional recurrence is an uncommon complication that may occur despite radical primary surgery. The role of preoperative radiotherapy for high-risk melanoma in this situation warrants investigation.
Specimen-orientated radiography helps define excision margins of malignant lesions detected by breast screening
Authors: Dixon J M , Sekar O Ravi , Walsh J , Paterson D , Anderson T J 
Published: March 2007

Abstract
Eighty patients with impalpable breast lesions detected by mammographic screening underwent hookwire-guided wide local excision. Excision specimens were orientated with Ligaclips and submitted to radiography; if on the specimen radiograph, the mammographic lesion crossed any visible margin, further tissue was excised. Clear histological margins were obtained on the initial excision in 52 (68 per cent) of 77 carcinomas. After inspection of the orientated specimen radiograph, further tissue was excised from 22 patients; this significantly increased the rate of complete excision to 86 per cent (P &lt;0·01). Significantly more patients with invasive cancer had a complete excision than those with ductal carcinoma in situ (52 of 57 versus 14 of 20, P &lt;0·02).
Effects of surgery on the generation of lymphokine-activated killer cells in patients with breast cancer
Authors: McCulloch P G , Macintyre A 
Published: March 2007

Abstract
Natural killer (NK) cell activity and the capacity to generate lymphokine-activated killer (LAK) cell activity were studied in 43 patients with operable breast cancer before and after surgery. Results were compared with those from ten healthy subjects. Patients with breast cancer had normal LAK and NK cell activity before surgery. A subgroup of patients with stage III disease had depressed LAK cell activity (P &lt; 0·013). NK cell activity decreased by over 50 per cent on the first day after surgery and did not return to preoperative levels by day 7 (P &lt;0·0005). Generation of LAK cell activity was unaffected by surgery. The addition of 10 per cent autologous plasma to the culture medium during the induction of LAK cell activity in vitro did not suppress LAK cell activity in patients with breast cancer. These results suggest that perioperative adjuvant immunotherapy based on interleukin 2 and LAK cells is not ruled out by systemic suppressive effects from either cancer or surgery.
Method for diagnosing rejection in small bowel transplantation
Authors: Grover R , Lear P A , Ingham Clark C L , Pockley A G , Wood R F M 
Published: March 2007

Abstract
Diagnosis of rejection in small bowel transplantation by the identification of a host-cell infiltrate is hampered by the physiological trafficking of host lymphocytes to the ‘gut-associated lymphoid tissue’ of the graft. This study compared physiological host-cell infiltration of small bowel grafts with that occurring in rejection and stable immunosuppression. Physiological host-cell infiltration, where the graft does not present an immune stimulus to the host, was assessed by transplanting bowel from DA to (DA × PVG) F1 hybrid rats. The extent of host-cell infiltration was determined by immunohistochemical analysis. In the lamina propria, considerable infiltration by host cells was seen, although it was significantly less than that in rejection or stable immunosuppression. By contrast, host cells were seen in the intraepithelial compartment only in rejection. Host-cell infiltration in the absence of an allogeneic stimulus suggests that histological identification of host cells in the lamina propria is not necessarily indicative of rejection. However, the presence of host cells in the intraepithelial compartment is specific for rejection in small bowel transplantation.
Pattern of recurrence after hepatic resection for colorectal metastases
Authors: Sugihara K , Hojo K , Moriya Y , Yamasaki S , Kosuge T , Takayama T 
Published: March 2007

Abstract
Between 1978 and 1989, 159 patients with liver metastases from colorectal cancer underwent hepatic resection. Of 134 patients in whom metastases were confined to the liver, 109 had tumours removed completely with histologically negative resection margins. Two patients died in hospital. Ultrasonographically guided partial resection was performed in 80 patients, lateral segmentectomy in seven and lobectomy in 22. The 5-year survival rate of patients undergoing potentially curative resection was 47·9 per cent. Patients with metachronous tumours showed a significantly better prognosis than those with synchronous lesions in both univariate (P &lt;0·01) and multivariate (P = 0·01) analysis. During a median follow-up of 35·4 months, 64 patients developed recurrence, including 34 in the liver, 20 in the lung and 12 in the abdominal cavity. Of those with hepatic recurrence, ten patients developed tumours at the initial resection bed, seven in the same lobe, five in the contralateral lobe and 12 in both lobes. Ultrasonographically guided partial liver resection did not increase the risk of hepatic recurrence.
Growth rate and percentage hepatic replacement of colorectal liver metastases
Authors: Purkiss S F , Williams N S 
Published: March 2007

Abstract
The growth of 32 untreated colorectal liver metastases and hepatic parenchymal volume in 11 patients were studied using planimetry of computed tomographic images. The median percentage hepatic replacement (PHR) of metastases was 0·49 (range 0·09–18·2). At subsequent assessment a median of 72 (range 14–235) days later, metastases were significantly larger with a median PHR of 1·78 (range 0·10–22·9) (P &lt;0·001). To compare the growth of metastases with variable PHR, logarithmic changes of PHR over 100 days were studied. This parameter was shown to be reduced in metastases of larger volume. The median (interquartile range) non-neoplastic hepatic parenchymal volume was found to increase from 1839 (1647–1997) to 2200 (1590–2401) cm3 (P = 0·005) as metastatic burden increased. These findings suggest that the growth of colorectal hepatic metastases is more complex than a simple process of hepatic replacement.
Role of serum endotoxin and antiendotoxin core antibody levels in predicting the development of multiple organ failure in acute pancreatitis
Authors: Windsor J A , Fearon K C H , Ross J A , Barclay G R , Smyth E , Poxton I , Garden O J , Carter D C 
Published: March 2007

Abstract
It has been proposed that endotoxin contributes to the development of multiple organ failure (MOF) in acute pancreatitis. Endotoxaemia is transient and may not be detected by intermittent blood sampling. By contrast, not only can changes in the patient's endogenous antiendotoxin core antibody pool persist for many days, but depletion of this pool may be a key event in determining the physiological significance of endotoxaemia. A series of 33 patients with acute pancreatitis had daily measurement of Acute Physiology Score (APS) and levels of C-reactive protein, interleukin 6, endotoxin, immunoglobulin (Ig) G and IgM antiendotoxin core antibodies, and prospective documentation of complications. Endotoxin was detected in the serum of 13 patients, while a significant change in levels of endogenous antiendotoxin core antibodies was detected in all those with severe pancreatitis and in 28 overall. MOF developed in seven patients, five of whom died. The combination of a rising APS over the first 48 h of admission and a significant fall in endogenous IgG antibody level was observed in all patients who developed MOF (seven of seven), but in only one of 16 without MOF (P = 0·00003; overall predictive value 91 per cent). This study suggests that measuring the initial trend in APS and the concentration of endogenous IgG antiendotoxin core antibody provides a means of identifying patients with acute severe pancreatitis who are at high risk of developing MOF. This group might benefit from passive immunotherapy with antiendotoxin antibodies.
Probability of rejection predicted from ultrasonographic measurement of renal transplant swelling
Authors: Nicholson M L , Bell A , Burton P R , Donnelly P K , Veitch P S , Bell P R F 
Published: March 2007

Abstract
Serial ultrasonographic measurements of renal transplant crosssectional area were used to quantify allograft swelling as a diagnostic test of acute rejection. Eighty consecutive episodes of acute allograft dysfunction (rise in creatinine level ⩾ 10 per cent or ⩾ 30 μmol l−1) were investigated. Needle core biopsy was performed in all cases to diagnose acute rejection. Rejecting transplants demonstrated a median (interquartile range) swelling of 16·2 (12·1–25·5) per cent compared with 2·2 (−2·0 to 8·4) per cent for non-rejecting organs (P &lt; 0·001). A ⩾ 10 per cent increase as the diagnostic threshold for rejection yielded a sensitivity of 80 per cent, specificity of 77 per cent, positive predictive value of 85 per cent, negative predictive value of 71 per cent and overall accuracy of 79 per cent. Using a logistic regression model, predictive probabilities of rejection for individual changes in cross-sectional area were calculated. A 20 per cent increase was associated with a predicted probability of rejection of 87 per cent (95 per cent confidence interval 75–94 per cent). There was a significant correlation between the functional severity of rejection and the degree of transplant swelling (rs = 0·63, P &lt; 0·001). Ultrasonographic measurement of renal transplant cross-sectional area is a simple non-invasive test for the diagnosis of acute rejection.
Fistula complicating restorative proctocolectomy
Authors: Keighley M R B , Grobler S P 
Published: March 2007

AbstractTwenty-seven patients developed a fistula after 168 restorative proctocolectomies. Thirteen fistulas were enterocutaneous (two with communication to the bladder); their origins were from the pouch (three patients), the ileoanal anastomosis (three), the pouch appendage (three), a previous loop ileostomy (two) and iatrogenic small bowel injury (two). Two patients had Crohn's disease. The pouch was removed in four patients, one of whom died from chronic small bowel obstruction; the remaining nine have satisfactory pouch function after fistula excision. Ten pouch–vaginal fistulas occurred, all from the ileoanal anastomosis; four were extrasphincteric. Four of these patients had underlying Crohn's disease. Only two patients, with Crohn's disease and indeterminate colitis, required pouch excision; the remainder have good pouch function after treatment of the fistula. There were three pouch–perineal fistulas, all from the ileoanal anastomosis; these were successfully managed by seton fistulotomy. There was one pouch–vesical fistula, successfully treated by excision of the fistula and pouch appendage.
Relationship between intra-abdominal and intrarectal pressure in the proctometrogram
Authors: MacDonald A , Paterson P J , Baxter J N , Finlay I G 
Published: March 2007

Abstract
During normal defaecation the intrarectal pressure increases but, in the absence of a reference catheter in the pelvis, the contribution of abdominal straining and rectal contraction to this rise is unclear. Anorectal manometry was performed in ten consecutive women with no gastrointestinal symptoms in an attempt to measure intrapelvic pressure using a catheter in the bladder. During filling the mean(s.e.m.) rectal pressure increased from 2(1) to 18(4) cmH2O. The mean(s.e.m.) intravesical pressure remained unchanged at 2(1) cmH2O. Evacuation of the rectal balloon produced an increase in mean(s.e.m.) intrarectal pressure from 18(4) (end-filling pressure) to 68(15) cmH2O. The mean(s.e.m.) intravesical pressure increased from 2(1) to 51(18) cmH2O. The true intrarectal pressure (intrarectal minus intravesical) did not rise during defaecation. The rise in intrarectal pressure during rectal evacuation occurs by increased intrapelvic pressure alone.
Idiopathic slow-transit constipation
Authors: Macdonald A , Baxter J N , Finlay I G 
Published: March 2007

Abstract
Until recently, the surgical management of idiopathic slow-transit constipation had remained unchanged since the condition was first described by Arbuthnot Lane in 1908. Although colectomy and ileorectal anastomosis is a successful treatment for the majority of patients, symptoms persist or are worse in some cases following such surgery. The previously inaccessible colon is now an area of interest in both health and disease; recent observations on aetiology, clinical investigation, neuropathology and surgical outcome lead us to question the rationale of colectomy for all patients with severe constipation.
Systemic leakage during isolated limb perfusion for melanoma
Authors: Klaase J M , Kroon B B R , Van Geel A N , Eggermont A M M , Franklin H R 
Published: March 2007

Abstract
A hazard of regional perfusion for melanoma is incomplete isolation, resulting in leakage of the cytostatic drug into the systemic circulation. Data were analysed retrospectively on 438 melphalan perfusions performed for melanoma of the extremities during the period 1978-1990; continuous isotopic measurement of systemic leakage was carried out. The cumulative systemic leakage after 60 min perfusion was 0·9 per cent (95 per cent confidence interval 0·7-1·1 per cent). Systemic leakage of ≧ 1 per cent was detected in 12·6 per cent of perfusions, ≧ 5 per cent in 6·2 per cent and ≧ 10 per cent in 1·4 per cent. In 2·3 per cent of patients, systemic side-effects in the form of mild transient bone marrow depression occurred. Six variables related to the perfusion technique were assessed by multivariate analysis for their influence on systemic leakage. The level of isolation and diameter of the venous cannula emerged as significant factors. In addition, ligation of the internal iliac vein provided optimal isolation during iliac perfusion.
Pathophysiology, recognition and management of pneumoretroperitoneum
Authors: Prêtre R , Robert J , Mirescu D , Witzig J-A , Rohner A 
Published: March 2007

Abstract
The medical records of 15 patients found to have pneumoretroperitoneum in a 10-year period were reviewed. The cause of retroperitoneal emphysema was infection in six patients, trauma in five and iatrogenic in four. Emphysema was confined to the retroperitoneum in 11 patients, and extended to the mediastinum in four and to the soft tissue of the neck in three. Failure to diagnose pneumoretroperitoneum resulted in delayed intervention in two patients. One patient with pneumoretroperitoneum and pneumoperitoneum secondary to a lung lesion underwent unnecessary laparotomy. Outcome was favourable in these three patients. The presence of air in the retroperitoneum is not dangerous but its early recognition and detection of the source are important as septic conditions may be involved.