bluuebunny/crossref_metadata_2025_split huggingface dataset:
The sphinctometer: A new device for measurement of lower oesophageal sphincter function
Authors: Gotley D C , Barham C P , Miller R , Alderson D , Arnold R 
Published: March 2007

Abstract
Current evidence suggests that lower oesophageal sphincter (LOS) competence depends upon both pressure and length. Existing devices can measure length and pressure, but not simultaneously. This methodological problem is a fundamental drawback to understanding LOS function and its role in oesophageal disease. A ‘sphinctometer’ has been developed, consisting of an oil-filled 3-mm diameter Silastic chamber, 6 cm in length, incorporating a pressure microtransducer designed to provide an integrated pressure reading as a function of length. Its performance has been tested in vitro using human cadaver oesophagus in a specially constructed chamber in which sphincter length and pressure can be varied independently. Comparisons were made with a conventional pull-through technique. Sphinctometer response was linear throughout the LOS pressure range of 0 to 50 mmHg at a fixed LOS length (RS = 0·99; P &lt; 0·001). Sphinctometer response was also linear at fixed LOS pressure for sphincter lengths from 1 to 6 cm (RS = 0·99; P &lt; 0·001). This device thus appeared suitable for monitoring function of the human LOS, and has subsequently been successfully incorporated into an ambulatory system for patient use.
Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: Phase II study with methotrexate and 5-fluorouracil
Authors: Plukker J Th , Verschueren R C J , Mulder N H , Sleijfer D Th , Grond J 
Published: March 2007

Abstract
Locally advanced cancer of the cardia and fundus might be cured by surgical resection. Poor results after surgery in stage IIIB and stage IV disease prompted a study of neoadjuvant chemotherapy. Treatment included four cycles of high doses of methotrexate (1·5 g/m2) and high doses of 5-fluorouracil (1·5 g/m2) followed by surgery in those patients with lesions then found to be resectable. Twenty patients with tumours staged as IIIB or IV were entered; 17 patients completed the four courses of chemotherapy and 14 underwent re-exploration. Eight patients achieved tumour reduction enabling resection. Five patients underwent total gastrectomy with distal pancreatectomy and splenectomy en bloc and three patients had an oesophagogastrectomy. There were no treatment-related deaths and toxicity was tolerable. Two patients were alive 54 and 41 months after chemotherapy with no evidence of disease. Locoregional recurrence developed in five patients and metastatic disease in one. Their median survival was 22 months.
Gallbladder sepsis after stent insertion for bile duct obstruction: Management by percutaneous cholecystostomy
Authors: Ainley C C , Williams S J , Smith A C , Hatfield A R W , Russell R C G , Lees W R 
Published: March 2007

Abstract
Of 364 patients undergoing insertion of a biliary endoprosthesis in 1989, six (1·6 per cent) developed gallbladder sepsis. Three patients had cholangiocarcinoma, two had carcinoma of the pancreas and one had a benign biliary stricture. Two of the five patients with malignancy had gallbladder stones, and the patient with a benign stricture developed stones after 3 years of stenting. Three patients developed gallbladder sepsis early after endoprosthesis insertion (&lt; 6 days), while in the other three it occurred late (&gt; 6 months). All six patients failed to respond to antibiotics and were successfully managed by percutaneous cholecystostomy; the patient with a benign biliary stricture also had cholecystolithotomy. The gallbladder drainage tubes were removed or became dislodged at intervals varying from 2 weeks to 6 months without complications. Percutaneous cholecystostomy is the treatment of choice for gallbladder sepsis unresponsive to antibiotics in patients with a biliary endoprosthesis in situ.
Influence of cholecystectomy on symptoms
Authors: Bates T , Harrison M , Ebbs S R , A'Hern R P 
Published: March 2007

Abstract
A group of 292 consecutive patients underwent cholecystectomy for gallstones with presumed biliary pain over a 4-year period and all completed a self-assessment questionnaire before operation. Over the following 2 years 18 patients died but no others were lost to follow-up. The remaining 274 patients completed a further questionnaire 1 and 2 years after operation. Demographic characteristics and abdominal symptoms have been compared with an age- and sex-matched control group using the same questionnaire. Before operation symptoms of flatulent dyspepsia were far more frequent in patients with gallstones but operation markedly reduced these symptoms to an incidence which almost matched that of the control group. However, 1 year after cholecystectomy 34 per cent of patients still suffered some abdominal pain and of 35 patients referred back to hospital for investigation none has been shown to have a retained bile duct stone at a minimum follow-up of 5 years. A multivariate analysis indicated that preoperative flatulence together with long duration of attacks of pain are risk factors for postoperative dissatisfaction as judged by a linear analogue scale. However, both these factors are common and neither is a good discriminator of a poor outcome. The prediction of a poor symptomatic outcome after cholecystectomy from preoperative symptoms or patient characteristics had only limited success and all patients should be warned of this risk.
Non-operative management of blunt liver injuries
Authors: Hollands M J , Little J M 
Published: March 2007

Abstract
Over a 10-year period 281 patients with liver injuries following blunt abdominal trauma were seen at Westmead Hospital. A decision to treat the liver injury without an operation was made in 55 (20 per cent) of the 281 patients. Two of these 55 patients required a subsequent laparotomy, one for continued bleeding and one for a bile leak. No patient died from a missed intra-abdominal or retroperitoneal injury or from concealed haemorrhage. These patients were compared with 181 patients with liver injuries who were operated on. The two groups of patients could be distingushed in terms of their clinical status on arrival at the hospital, the magnitude of their injury and the sequelae of the injury. Non-operative management proved a safe alternative to an operation in appropriate patients, but a laparotomy to exclude unsuspected intra-abdominal injuries is associated with little significant morbidity and offers some reassurance in managing patients with multiple injuries.
Pancreatic pseudocysts: A proposed classification and its management implications
Authors: D'Egidio A , Schein M 
Published: March 2007

Abstract
Pancreatic pseudocysts in 83 patients were classified according to clinical and radiographic criteria. Group I (45 patients) had acute, ‘post-necrotic’ pseudocysts with normal pancreatic duct anatomy and rarely duct—pseudocyst communication. Percutaneous drainage was curative in all patients in whom it was used. Group II (26 patients) included ‘post-necrotic’ pseudocysts developing in patients already suffering from chronic pancreatitis. The pancreatic duct was diseased but not strictured, and duct—pseudocyst communication was often present. Percutaneous drainage is possible for such patients but it may have to be prolonged; surgical internal drainage was usually successful. Group III (12 patients) had chronic ‘retention’ pseudocysts. The pancreatic duct was grossly diseased and strictured and duct—pseudocyst communication was present in all cases. Percutaneous drainage is contraindicated and surgical internal drainage has a high recurrence rate. Operative procedures in this group should address the specific ductal pathology. An improved classification of pseudocysts could help the surgeon to choose the most appropriate form of treatment.
Controlled trial of polyglycolic acid versus catgut and nylon for appendicectomy wound closure
Authors: Wetter L A , Dinneen M D , Levitt M D , Motson R W 
Published: March 2007

Abstract
Six hundred and fifty patients undergoing appendicectomy were included in a prospective randomized controlled trial. At operation patients were allocated to control (chromic catgut ligatures and muscle closure, nylon skin closure) or study (polyglycolic acid ligatures and muscle and skin closure) groups. Wounds were examined by an independent observer daily in hospital and 1 month after operation. Wound infection was defined as discharge of serous or purulent material, or a grossly inflamed wound without discharging pus, or any evidence of intra-abdominal sepsis. Of the 650 patients (335 men, 315 women, age 5–80 years, median 18 years), 615 have completed follow-up. Groups were well matched for age, sex, degree of sepsis at operation, histological diagnosis and surgeon. Infection was significantly reduced in the study (polyglycolic acid) group (12·0 per cent) compared with the control (chromic catgut/nylon) group (21·2 per cent) (ξ2 = 9·3, P = 0·002). Infection was significantly reduced in the polyglycolic acid group regardless of whether the appendix was inflamed or normal. These results indicate that suture material can influence the incidence of wound infection and that this is less frequent when polyglycolic acid sutures are used.
Comparison of iliofemoral and femorofemoral crossover bypass in the treatment of unilateral iliac arterial occlusive disease
Authors: Hanafy M , McLoughlin G A 
Published: March 2007

Abstract
Between 1981 and 1988, 74 synthetic crossover bypass grafts were inserted for unilateral iliac arterial occlusive disease. In 32 patients the bypass procedure was iliofemoral and in 42 femorofemoral. The cumulative patency rate at a mean of 2·7 years was 79 per cent in both groups. There was no significant difference in either postoperative mortality rate or duration of hospital stay. Iliofemoral bypass may offer significant advantages over the femorofemoral approach. In particular it avoids a groin incision in the donor limb, leaving the common femoral artery intact for subsequent angioplasty or reconstruction should proximal stenotic disease develop in the donor iliac vessel.
Cervical spine injuries in patients with head injuries
Authors: Soicher E , Demetriades D 
Published: March 2007

Abstract
It is generally believed that significant head injury after a traffic accident or fall is associated with a high incidence of concurrent cervical spine injury. This study prospectively examined 260 victims of traffic accidents or falls with significant head injury. The incidence of associated cervical spinal injury was only 3·5 per cent. There was no association between the severity of head injury and the incidence of cervical spine injury. The risk of concurrent spinal injury in head injury patients is not higher than the reported risk in patients without head injury. Although care should be taken to protect the cervical spine in patients with head injury, the results of the present investigation show that the risk of cervical spine injury is much less than previously reported.
Endothelium-derived relaxing factor and vein grafts
Authors: Komori K , Okadome K , Sugimachi K 
Published: March 2007

Abstract
Platelet thrombosis, intimal hyperplasia and progression of atherosclerosis are the most important factors determining the patency of vein grafts for arterial occlusive disease. Interactions between aggregating platelets and the vessel wall play an important role in all of these processes. Recently, it has become evident that the endothelium modulates the underlying vascular smooth muscle by releasing an endothelium-derived relaxing factor, a potent vasodilator and anti-aggregating substance. Little information is available, however, on such endothelial functions of autogenous vein grafts. This review focuses on vascular modulation by endothelium-derived relaxing factor in vein grafts.
Postsplenectomy sepsis and its mortality rate: Actual versus perceived risks
Authors: Holdsworth R J , Irving A D , Cuschieri A 
Published: March 2007

Abstract
A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12 514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be no more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.
Clinical and functional outcome after restorative proctocolectomy
Authors: de Silva H J , de Angelis C P , Soper N , Kettlewell M G W , Mortensen N J McC , Jewell D P 
Published: March 2007

Abstract
Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P&lt;0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P&lt;0.001). Twenty-five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouches.
Surgical restraint in the management of liver trauma
Authors: Watson C J E , Calne R Y , Padhani A R , Dixon A K 
Published: March 2007

Abstract
Previous experience in Cambridge in the management of liver trauma has led to the evolution of a protocol for surgical intervention to secure control of haemorrhage from the injured liver. We report 80 cases of liver trauma including 12 who were initially managed non-operatively; three of these subsequently required operation. Of the 80, all but five suffered blunt abdominal trauma. Perihepatic packing was used to manage 29 patients, of whom 21 were initially treated elsewhere before being transferred to Cambridge. Six of these required a hemihepatectomy at subsequent exploration. Of the 39 patients who underwent urgent laparotomy and definitive surgery, 11 (28 per cent) died; only three out of 29 (10 per cent) died after initial packing. Only one death from hepatic complications occurred after packing and subsequent transfer.
Graft versus host disease in small bowel transplantation
Authors: Ingham Clark C L , Price B A , Malcolm P , Lear P A , Wood R F M 
Published: March 2007

Abstract
Quantities of organized lymphoid tissue in small bowel allografts may cause graft versus host disease (GVHD) following transplantation. This study examines the effect of graft mesenteric lymphadenectomy on development of GVHD following small bowel transplantation in rats. GVH reactivity was assessed by measuring the degree of graft cell emigration to the host. In the PVG to DA strain combination, graft mesenteric lymphadenectomy led to a significant reduction in graft cell colonization of host lymphoid tissues from 40–50 per cent to 25–35 per cent. Transplantation from PVG to (PVG × DA)F1 hybrids caused fatal GVHD within 21 days whereas when DA donors were used survival was over 30 days. When mesenteric lymphadenectomy was performed on PVG donors, host survival increased by only 3–4 days. Mesenteric lymphadenectomy in DA donors led to long-term recipient survival with no GVHD. Intensity of GVHD following rat small bowel transplantation is a strain-dependent phenomenon and graft mesenteric lymphadenectomy does not always prevent GVHD. The mucosa may have an important immunological role.
Injection sclerotherapy for bleeding varices: Risk factors and complications
Authors: McKee R F , Garden O J , Carter D C 
Published: March 2007

Abstract
Risk factors for complications after injection sclerotherapy were studied in 163 patients undergoing 667 treatments for bleeding oesophageal varices. The overall mortality rate was 7 per cent per injection sclerotherapy session; 16 per cent per acute session and 2.4 per cent per elective session. Acute variceal bleeding was controlled by injection sclerotherapy in 91 per cent of patients. Complications occurred after 16 per cent of injection sclerotherapy sessions. Deaths and complications were significantly associated with poor modified Child's grading (P&lt;0.001), the first variceal bleed (P&lt;0.001), acute injection sclerotherapy (P&lt;0.001) and the use of the rigid oesophagoscope (P&lt;0.001).
Perineal injuries in children
Authors: Jones L W , Bass D H 
Published: March 2007

Abstract
Over a 12-year period, 463 children under 13 years of age were treated for perineal injuries. The most common cause of injury was a fall astride, but motor vehicle trauma and rape were responsible for most of the severe and multiple injuries. Physical or sexual abuse was evident in 178 (38 per cent) of children, and four sustained injuries from forceful enema. Minor abrasions or first degree tears (88 per cent) and second degree tears (6 per cent) were sutured primarily or allowed to granulate with sepsis rates of 1.2 per cent and 14 per cent respectively. Twenty-nine (6 per cent) children sustained third degree lacerations; one died from secondary pelvic haemorrhage. In the 28 survivors, the outcome of primary (18) or delayed (ten) surgical repair was related to whether or not early defunctioning colostomy had been performed.
Ruptured aortic aneurysm: A proposed classification
Authors: Callam M J , Haiart D , Murie J A , Ruckley C V , Jenkins A McL 
Published: March 2007

Abstract
There is a wide variation in reported operative mortality rates for ruptured abdominal aortic aneurysm, ranging from 14 to 70 per cent. Although many factors influence this variation, such as the expertise and facilities available at an individual institution, considerable differences could be due to variations in the pattern of referral and the proportion of cases accepted for operation. In this paper a classification applicable to all patients with ruptured aortic aneurysm is proposed; it has been applied prospectively to 100 consecutive patients with ruptured abdominal aortic aneurysm referred to the Edinburgh Vascular Surgical Unit. The classification illustrates how surgical mortality rates ranging from 29 to 52 per cent may be reported using the same mortality data. Two major benefits may derive from the use of such a standard reporting system. Firstly, it allows management deficiencies to be identified easily and, secondly, it should facilitate comparison of results reported from different centres.
Frequency of familial colorectal cancer
Authors: Stephenson B M , Finan P J , Gascoyne J , Garbett F , Murday V A , Bishop D T 
Published: March 2007

Abstract
Familial clustering of cancer is not uncommon. The frequency of familial colorectal cancer was estimated by taking family histories from 100 patients presenting with apparently sporadic colorectal cancer. Compared with controls, the relative risk of a positive family history for colorectal cancer was 4·6. Life-table methods were used to examine the observed to expected mortality from colorectal cancer. Overall there was a fourfold increase in mortality rate (P &lt; 0·0001), which was greatest in female relatives of patients with colonic cancer (P &lt; 0·001). Three families with dominant inheritance of colorectal cancer and one family with Lynch type II syndrome were identified. Nine per cent of patients had siblings who had developed colorectal cancer a median of 4 years before the diagnosis of the index patient (range 1–17 years). It is recommended that a careful family history should be obtained from all patients with colorectal cancer. Where a positive history is obtained a geneticist may determine empirical risks for the development of colorectal cancer and the appropriate method of surveillance may be selected.
Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy
Authors: Joyce W P , Keane R , Drumm J , Egan T J , Delaney P V , Burke G J , Daly M 
Published: March 2007

Abstract
To identify patients with common bile duct stones, all patients considered for laparoscopic cholecystectomy in this unit undergo intravenous cholangiography (IVC) with tomography and, more recently, operative cholangiography. To date 100 consecutive patients with symptomatic gallstones have undergone laparoscopic cholecystectomy with no specific exclusion criteria. Eight patients of 100 were found to have duct stones on IVC with one false-positive. These IVC data were compared with data from 52 patients who also had operative cholangiograms performed. One stone was detected on operative cholangiography that was not identified on IVC. No additional information was gained from operative cholangiography. These data suggest that preoperative IVC is adequate for the detection of duct stones in patients considered for laparoscopic cholecystectomy.
Ultrasonography in the acute abdomen
Authors: Davies A H , Cobb R , Mortensen N J McC , Mastorakou I , Rogers C , Lindsell D 
Published: March 2007

Abstract
In a prospective study 152 consecutive patients presenting with acute abdominal pain were assessed clinically and an ultrasonographic examination was performed immediately. Of these, 16 (11 per cent) patients would normally have had an immediate ultrasonographic scan requested; routine (within 24 h of admission) ultrasonographic examination would have been requested in a further 66 (43 per cent) patients. In 70 (46 per cent) patients an ultrasonographic examination would not have been requested. Ultrasonography altered the diagnosis in one patient from probable appendicitis to cholecystitis. Ultrasonography missed one abdominal aortic aneurysm and one empyema of the gallbladder. Ultrasonography had a sensitivity of 96 per cent, a specificity of 94 per cent, a positive predictive value of 96 per cent, a negative predictive value of 94 per cent and an accuracy of 95 per cent in diagnosing appendicitis. Exactly the same values were found for the clinical diagnosis of appendicitis. The study shows that routine immediate ultrasonographic examination of the acute abdomen is rarely helpful, with the possible exception of appendicitis. Where an urgent ultrasonographic scan is necessary on clinical grounds the expertise of a radiologist is probably required, whereas in specific areas, for example in the diagnosis of right iliac fossa pain, there may be a place for training the surgical trainee.