bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sample size in fine needle aspiration biopsy
Authors: Kreula J , Bondestam S , Virkkunen P 
Published: March 2007

AbstractThe weights of biopsy specimens from bovine liver taken for fine needle aspiration cytology (FNAC) by three groups of physicians, were compared. The groups differed from each other in their extent or degree of experience in FNAC. When the physicians used their normal technique, the mean sample weight increased significantly with experience, from 4·6 mg in the least experienced group to 17·2 mg in the group with the longest experience. Thirty-six per cent of the samples taken by the group with the least experience were in the weight class 0–2 mg, whereas no such samples were encountered for the other groups. When all the physicians were advised to use the same, standard technique there were no statistically significant differences in mean sample weight between the groups or in the proportion of samples in class 0–2 mg. Sample weights correlated significantly (P&lt;0·001) with cell counts. This study shows that differences in the technique of FNAC are responsible for differences in sample weights and cell counts, including the number of the acellular samples obtained. This could explain in some part the wide variation in the reported accuracy rates of FNAC.
Time-related changes in characteristics of prognostic significance in carcinomas of the oesophagus and cardia
Authors: Lund O , Hasenkam J M , Aagaard M T , Kimose H H 
Published: March 2007

Abstract
During 25 years (1960–84) 657 patients were operated on for squamous cell carcinomas (n = 230), adenocarcinomas (n = 399) or anaplastic carcinomas (n = 28) of the thoracic oesophagus or cardia. The male: female ratio was 2·8:1 and the mean age was 66 years (range 22–91 years). Oesophagogastrectomy (n = 514) was performed whenever technically possible. From the first (1960–64) to the last (1980–84) 5-year period the proportion of adenocarcinomas increased from 56 to 78 per cent (P &lt;0·001), poorly differentiated cancers increased from 34 to 65 per cent (P &lt;0·0001), and stage III-IV tumours increased from 72 to 88 per cent (P &lt;0·05). Five-year cumulative rates(s.e.) were 11(3) per cent for operations during 1960–69 (n = 262), 8(2) per cent during 1970–79 (n = 256) and 3(2) per cent during 1980–84 (n = 139; P &lt;0·05). Hospital mortality rates (·30 days) and 5-year cumulative survival rates(s.e.) were 6·5 per cent and 36(7) per cent (n = 46) for stage I, 14·0 per cent and 21(4) per cent (n = 114) for stage II, 17·8 per cent and 5(1) per cent (n = 258) for stage III and 23·8 per cent and 3(1) per cent (n = 239) for stage IV tumours (P &lt;0·05 and P &lt;0·001). Well differentiated (n = 70) cancers, those of medium differentiation (n = 239) and poorly differentiated cancers (n = 348) had 5-year survival rates(s.e.) of 24(5), 10(2) and 5(1) per cent, respectively (P = 0·0007). Squamous cell carcinomas had a better prognosis than adenocarcinomas, even after stratification according to location of primary tumour. The 657 patients who underwent surgery constituted 50 per cent of a total of 1316 cases with cancer of the oesophagus and cardia reported from our catchment area during the study period. Frequency of surgery decreased with age. The annual incidence (number per 100000 inhabitants aged 20 years or more) of adenocarcinomas of the lower oesophagus and cardia doubled to 5·9 in 1980–84, while that of squamous cell carcinomas tended to decrease (to 2·9). A successive worsening of long-term survival after surgery was explained by significant changes in cancer characteristics having pronounced prognostic significance. Over the 25 years the carcinomas changed towards the present pattern where poorly differentiated adenocarcinomas of the lower third of the oesophagus and cardia in stages III–IV have become predominant.
Modern aids to clinical decision-making in the acute abdomen
Authors: Paterson-Brown S , Vipond M N 
Published: March 2007

Abstract
Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.
Acute haemorrhage from gastric malignancy
Authors: Allum W H , Brearley S , Wheatley K E , Dykes P W , Keighley M R B 
Published: March 2007

Abstract
The presentation, pathology and treatment of 30 patients with acute bleeding from gastric malignancies has been reviewed. Patients usually have a history of symptoms of less than 6 months prior to bleeding. Adenocarcinoma was the commonest type of tumour, and 74per cent were stage IV lesions. The proportion of lesions in the body of the stomach (57per cent) was greater than expected, suggesting that these are different populations of gastric tumour. Laparotomy was undertaken in 20 patients, 12 of whom had a resection. Resection was associated with a median survival of 17·0 months. Those with unresectable tumours or who were treated only by supportive measures had a median survival of only 2·5 months (P &lt; 0·01). Evidence of peritoneal or liver involvement should contraindicate surgical intervention as these patients have a high postoperative mortality rate.
Gastrointestinal fistulas associated with large abdominal wall defects: Experience with 43 patients
Authors: Schein M , Decker G A G 
Published: March 2007

Abstract
Experience with 43 patients with gastrointestinal fistulas associated with a large abdominal wall defect is presented. The overall mortality rate was 60per cent; 37per cent in patients who underwent the primary procedure in the home unit and 74 per cent in those from elsewhere. An average of five operations per patient was performed. The abdominal wall defect developed spontaneously as a consequence of postoperative peritonitis in 24 patients (mortality rate, 71 per cent) and was created intentionally as apart of the ‘open management’ in 19 cases (mortality rate, 47per cent). Errors in management were identified in 63per cent of the patients and this adversely influenced the outcome. Patients with this condition should be referred early to tertiary care facilities where diversion of the intestinal leak away from the defect, prompt control of the associated intra-abdominal infection and adequate handling of the defect itself can be performed.
Evaluation of the prognostic value of triple node biopsy in early breast cancer
Authors: du Toit R S , Locker A P , Elis I O , Elston C W , Blarney R W 
Published: March 2007

Abstract
The prognostic information obtained by triple node biopsy (low axillary, apical axillary and internal mammary nodes) in 693 patients with early breast cancer has been reviewed. Results show that tumour site within the breast influenced which nodal groups were involved. The low axillary node contributed the most useful prognostic information. The involved apical node carried the worst prognosis. Either the internal mammary node or a low axillary node when positive alone carried the same prognostic weight. When both nodes were positive the prognosis declined to the level associated with apical node positivity. A double node biopsy of the low axillary node and either the apical or the internal mammary node gave the same maximum prognostic information as a triple node biopsy. The triple node biopsy technique can be used to divide patients into groups with vastly different prognoses.
Synthesis of prostaglandins I2 and E2 by the canine gallbladder in vitro: Studies using a new incubation chamber
Authors: England D W , Jaffe B M , Webb H , Hoover E L 
Published: March 2007

Abstract
Using a specially designed incubation chamber, differential synthesis and the response to added arachidonic acid (25 mm) and l-α-phosphatidylcholine (LAP; 2mM) was quantified in gallbladders from male and female dogs. Prostaglandin I2 (PGI2) was the predominant prostanoid synthesized, and tissues from females produced much more PGI2 under basal conditions than did gallbladders harvested from male dogs. Addition of arachidonic acid stimulated PGI2 synthesis by almost 100 per cent. Arachidonate-stimulated mucosal and serosal production of PGI2 were (mean(s.e.m.)) comparable, 343(178) and 375(89) pg/cm2/min, respectively. Gallbladders from female animals synthesized significantly more PGI2 than did tissue from males. Indomethacin inhibited PGI2 synthesis in a dose–response manner; at 7 × 10−5m, prostanoid synthesis was inhibited by &gt;80 per cent. Arachidonic acid did not stimulate prostaglandin E2 (PGE2) production by gallbladder tissue. LAP similarly stimulated PGI2 biosynthesis, but in contrast to the effect of arachidonic acid, the effect was significantly greater in the serosa than the mucosa, 355(107) and 213(59) pg/cm2/min, respectively. LAP also stimulated PGE2 biosynthesis by the canine gallbladder in a pattern very similar to that of PGI2. Based on the differences in response to the two agents added, we conclude that arachidonic acid and l-α-phosphatidylcholine stimulate prostaglandin biosynthesis via independent pathways. We advocate the use of the incubation chamber for the assessment of prostanoid biosynthesis by the gallbladder in vitro.
Impact of duplex scanning on carotid endarterectomy
Authors: Chant A D B , Thompson J F , Stranks G J , Ranaboldo C , Humphries K N , Hames T K , Clifford P C 
Published: March 2007

Abstract
Duplex ultrasound permits safe and accurate assessment of the extracranial vasculature. This paper reports the change in patterns of referral to a specialized vascular unit following its introduction; increased referrals were seen in all specialities except neurology. A widely available and reliable duplex service has revealed more extracranial vascular disease than was previously recognized, and has increased referrals for carotid endarterectomy, thereby increasing surgical workload.
Prospective study of colorectal cancer in the West of Scotland: 10-year follow-up
Authors: McArdle C S , Hole D , Hansell D , Blumgart L H , Wood C B 
Published: March 2007

Abstract
Six hundred and forty-five patients presenting with colorectal cancer over a 6-year period were studied prospectively. At the time of presentation almost half the patients had clinical evidence of local tumour fixity and over one-quarter had distant metastases. The overall resectability rate was 70·8 per cent, apparently curative resection being obtained in 52·5 per cent. Overall operative mortality rate was 13·8 per cent, increasing in the elderly. Approximately 70 per cent of patients undergoing ‘curative’ resections survived for 2 years, 50 per cent survived for 5 years and 40 per cent survived for 10 years. After palliative resection approximately 10 per cent of patients survived for 5 years; only six of 133 patients (4 per cent) undergoing palliative diversion survived for 2 years. This prospective study confirms the advanced stage of colorectal cancer as it presents to a non-specialist centre. Although the poor outlook is largely a consequence of the advanced nature of the disease, there is evidence to suggest that the results of surgical intervention could be improved.
Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery
Authors: Meijer W S , Schmitz P I M , Jeekel J 
Published: March 2007

Abstract
In this study all available clinical trials of antibiotic prophylaxis in biliary tract surgery, published from 1965 to 1988, were examined. Results of 42 randomized, controlled trials (4129 patients), in which a group of patients treated with antibiotics was compared with a group of patients not treated with antibiotics, were pooled. Wound infection rates in the control groups range from 3 to 47 per cent and are 15 per cent overall. The overall difference in infection rates is 9 per cent in favour of antibiotic treatment (95 per cent confidence interval 7–11 per cent), while the common odds ratio is 0·30 (95 per cent confidence interval 0·23–0·38). Subgroup meta-analysis showed a significant stronger protective effect in high risk patients, while the timing of wound inspection (i.e. early in hospital or late at follow-up) markedly influenced the treatment effect reported. Comparison of wound infection rates in patients treated with first generation versus second or third generation cephalosporins (11 trials, 1128 patients), as well as single-dose versus multiple-dose regimens (15 trials, 1226 patients) did not reveal any significant effect (P &gt; 0·05) in each trial separately as well as in the overall comparison. The results indicate that there is evidence against further use of no-treatment controls and that the choice of treatment regimen can largely be made on the basis of cost.
Progressive pneumoperitoneum in the management of giant incisional hernias: A study of 41 patients
Authors: Caldironi M W , Romano M , Bozza F , Pluchinotta A M , Pelizzo M R , Toniato A , Ranzato R 
Published: March 2007

Abstract
Forty-one patients (17 men and 24 women) were treated with progressive pneumoperitoneum before repair of giant incisional hernias. The pneumoperitoneum was induced using nitrous oxide gas and a laparoscopic insufflator, and was topped up every other day for a mean of 5·5 days with a total injection of 23·2 litres of nitrous oxide. The pneumoperitoneum was well tolerated in 30 patients, caused a mild temporary pain in 10 patients and a sharp pain in one patient; no serious side-effects occurred. All the patients underwent surgery to repair their hernias, 40 patients were available for follow-up for a mean of 25·3 months, only two hernias recurred both within 4 months of the operation.
Skeletal muscle enzyme activities and metabolic substrates during exercise in patients with postoperative fatigue
Authors: Christensen T , Nygaard E , Stage J G , Kehlet H 
Published: March 2007

Abstract
Subjective fatigue was quantified before and 20 days after uncomplicated elective abdominal surgery in 12 patients and compared with changes in heart rate, enzyme activities and skeletal muscle substrates before and after bicycle exercise for 10 min at 65per cent of patients' preoperative maximum work capacity. Fatigue increased from a mean(s.e.m.) preoperative level of 2·5(0·5) arbitrary units to 4·6(0·5) on postoperative day 20 (P&lt;0·01). Body-weight, triceps skinfold thickness and arm circumference decreasedpostoperatively (P&lt;0·02). Postoperative values of muscle enzyme activities indicative of oxidative phosphorylation capacity (citrate synthase and 3-OH-acyl coenzyme A dehydrogenase) were lower than preoperative values (P&lt;0·05). Lactate dehydrogenase was unaltered and resting values of muscle glycogen and adenosine triphosphate were higher after operation (P&lt;0·05). In response to exercise, heart rate, muscle glucose, glucose-6-phosphate and lactate increased (P&lt;0·05), while muscle glycogen and creatine phosphate decreased (P&lt;0·05). Increase in postoperative fatigue correlated with the increase in heart rate (P&lt;0·05), while no significant correlations were found between fatigue and muscle parameters. Our results suggest that lack of exercise and malnutrition may be of importance in the decrease in work capacity and in fatigue after operation.
Asymptomatic gallstones
Authors: Gibney E J 
Published: March 2007

Abstract
The increasing detection of asymptomatic gallstones leads to difficult decisions for the surgeon and patient about whether the stones should be managed expectantly or surgically. This review examines the evidence currently available upon which such decisions must be based. Gallstones may present as biliary pain, acute cholecystitis, biliary obstruction or pancreatitis, but it is not clear who will develop symptoms and what are the commonest initial symptoms. Studies of the natural history of silent gallstones suggest that a large majority of patients with such stones will remain asymptomatic. However, diabetics are at increased risk, as are patients whose stones are detected initially at laparotomy. Incidental cholecystectomy is usually safe, and preoperative detection by ultrasonic screening is an advantage in planning the operation. Prophylactic cholecystectomy is not indicated to prevent gallbladder carcinoma (except in cases of porcelain gallbladder) and there is conflicting evidence about whether cholecystectomy predisposes to colorectal carcinoma.
Non-invasive estimation of peripheral resistance using Pulse Generated Runoff before femorodistal bypass
Authors: Scott D J A , Vowden P , Beard J D , Horrocks M 
Published: March 2007

Abstract
The measurement of peripheral resistance (PR) is a useful technique for predicting the outcome of femorodistal bypass. In an attempt, non-invasively, to predict PR, Pulse Generated Runoff (PGR) was used to assess 35 consecutive patients undergoing femorodistal non-reversed vein bypass for critical ischaemia. The PGR subscores (anterior tibial, posterior tibial, peroneal, pedal arch status were correlated against the measured PR. Using multiple linear regression three resistance values were derived for runoff at different levels: (1) a single calf vessel (R1); (2) distal popliteal artery (R3); (3) irrespective of the level (R0). There was good agreement between the predicted resistances RO, R1 and R3 and the measured PR. In the single calf vessel group (R1) the limits of agreement (−0·41 to +0·39) and 95 per cent confidence interval (−0·16 to +0·14) with the measured PR were better than in the R0 and R3 groups. These levels of agreement are small enough to replace the measured PR with the predicted PR method. Using the appropriate resistance equation in a further prospective series of 14 cases, there was agreement between the predicted and measured PR (limits of agreement −0·67 to +0·41; 95 per cent confidence interval −0·26 to +0·15). These results confirm the value of PGR in the assessment of critically ischaemic limbs particularly with a single calf vessel. Calf vessel continuity with the pedal arch appears to be a major determinant of PR, particularly in the isolated calf vessel group. A non-invasive resistance value can be derived which will predict the intraoperative peripheral resistance and should help predict subsequent graft outcome.
Urine acid output as a test of completeness of vagotomy
Authors: Johnson C D , Rai A S 
Published: March 2007

Abstract
Peak acid output in response to sham feeding and changes in urine acid output 2 and 3 hours after a test meal have been measured in 20 normal volunteers, 17 asymptomatic patients after vagotomy, six patients with recurrent duodenal ulcer after vagotomy and ten normal subjects given a 48-h course of ranitidine, 150 mg 12-hourly. Gastric peak acid output in normal volunteers ranged from 6·9 to 22·1 mmol/h. All asymptomatic patients after vagotomy had a peak acid output &lt; 7 mmol/h, consistent with complete vagotomy. Five patients with recurrent ulcer had a peak acid output &gt; 8 mmol/h, suggesting an incomplete vagotomy. Urine acid output after a test meal, expressed as the change from the basal rate of acid output, was always in a negative direction in normal subjects (fall in acid output = postprandial alkaline tide. This change was abolished in patients with complete vagotomy, in whom urine acid output increased after a meal. In five patients with incomplete vagotomy (and one other with recurrent ulcer and unknown vagal status) the urine acid output changed in a negative direction after a test meal. The relationship of urine acid output to gastric secretion was confirmed by the abolition of the postprandial alkaline tide in normal subjects given ranitidine. The results in patients with incomplete vagotomy did not overlap with those from patients with complete vagotomy. This suggests that this test could be used for the routine postoperative assessment of completeness of vagotomy.
Continuous 99mTc-HIDA infusion as a method for measuring duodenogastric reflux
Authors: Mompeán J A Luján , Paricio P Parrilla , Campos R Robles , Jímenez T Fuente , Gomez D Martínez 
Published: March 2007

Abstract
The continuous 99mTc-HIDA infusion test is presented as a method for measuring duodenogastric reflux as well as for studying biliary elimination of the compound when it is administered by constant intravenous infusion. Thirty patients were studied: (a) ten patients with a T tube placed in the biliary tree were used to study the elimination of 99mTc-HIDA in the bile; (b) ten normal subjects were used as a control group; and (c) ten patients were studied who had undergone Billroth I gastrectomy for peptic ulcer ation. Studies of subjects in groups (b) and (c) were used to assess duodenogastric reflux by this test, correlating it with the measurement of bile acids in gastric juice. When 99mTc-HIDA was administered by constant intravenous infusion it resulted in an increased elimination in bile for the first 80–100 min, and the concentration in bile then remained relatively constant for the rest of the test. With respect to the duodenogastric reflux study group, reflux rates in the patients who had been operated on were higher than those in the control group, with statistically significant differences. Minimum reflux rates were found in the normal subjects. Assessment of reflux by 99mTc-HIDA correlated closely with the results of bile acid concentrations in Billroth I patients (r = 0·75, P &lt; 0·001) and control subjects (r = 0·85, P &lt; 0·001). Our results demonstrate that continuous 99mTc-HIDA perfusion is a useful, accurate and objective method for measuring duodenogastric reflux.