bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strictureplasty without concomitant resection for small bowel obstruction in Crohn's disease
Authors: Tjandra J J , Fazio V W 
Published: March 2007

Abstract
The efficacy of strictureplasty in the treatment of Crohn's disease is often attributed in part to concomitant resection of strictured small bowel segments. Fifty-four patients with obstructive Crohn's disease who underwent 215 strictureplasty procedures (Heineke-Mikulicz, 179; Finney, 36) without concomitant resection of small bowel were reviewed. The median age was 38 (range 18–66) years and the median follow-up 3 (range 1–7) years. The mean number of strictureplasties per patient was 4 (range 1–13). Twenty-four patients had undergone at least one previous small bowel resection. There was no operative death. Intraabdominal abscess and enterocutaneous fistula occurred in two patients each and reoperation for sepsis was needed in one. At 1 year after surgery the median weight gain was 4 kg; all but two patients had relief of obstructive symptoms and 26 of 37 were weaned off steroids. Symptomatic recurrence occurred in 14 patients and seven required reoperation. Rates of recurrent stricture and of new stricture or perforative disease were 2·3 per cent of strictureplasty sites and 26 per cent of patients respectively.
Evaluation of direct and indirect inguinal hernia by computed tomography
Authors: Hahn-Pedersen J , Lund L , Højhus J Hansen , Bojsen-Møller F 
Published: March 2007

Abstract
The importance of venous distension of the pampiniform plexus in the prevention of inguinal hernia was evaluated. Functional closure of the inguinal canal was investigated by computed tomography during a Valsalva manoeuvre in a normal individual and 12 men with unilateral inguinal herniation, one of whom had previously undergone herniorrhaphy. Thus, 13 normal canals were evaluated along with five with direct and seven with indirect hernia. In all normal canals a rise in intra-abdominal pressure increased the cross-sectional area of the part of the pampiniform plexus located in the medial end of the canal, thereby filling the empty space and preventing herniation. In the lateral part the plexus was compressed against the external aponeurosis by the fascia transversalis in a valve-like fashion. In cases of direct inguinal herniation the distended pampiniform plexus was displaced by the hernia sac during the Valsalva manoeuvre, but in indirect hernia impaired swelling of the pampiniform plexus was seen. It is suggested that this observation could help to explain the normal mechanism of closure of the inguinal canal.
Bacterial translocation, intestinal ultrastructure and cell membrane permeability early after major liver resection in the rat
Authors: Wang X D , Pärsson H , Andersson R , Soltesz V , Johansson K , Bengmark S 
Published: March 2007

Abstract
The process and route of bacterial translocation from the gut after major liver resection remain unclear. In the present study enteric bacterial translocation, enterocyte ultra-structure in the ileum and colon, the process and route of bacterial invasion and the permeability of the cell membrane system and blood–tissue barrier were evaluated in rats receiving sham operation, and 70 or 90 per cent hepatectomy. The incidence of bacterial translocation to mesenteric lymph nodes was 80–100 per cent in rats 6 h after 70 per cent and 2–4 h after 90 per cent hepatectomy, and 80–100 per cent to the systemic circulation 2–4 h after 90 per cent hepatectomy but only 20 per cent to the portal vein. An increase in bacterial adherence to the intestinal surface, damage to the permeability of the cell membrane system and blood–tissue barrier, and pathological alterations in the ileum and colon developed, correlating with the extent of liver removed and the time that had passed after hepatectomy. Most translocating bacteria appeared in morphologically intact enterocytes with increased membrane permeability, in antigen-presenting cells and in submucosal lymphatics, but some bacteria were also seen within damaged enterocytes 4 h after 90 per cent hepatectomy. These results indicate that altered permeability of the cell membrane system may be one of the earliest characteristics of challenged enterocytes, and that enteric bacteria translocate through both morphologically normal and abnormal enterocytes. Translocation occurred mainly into the lymphatics, bacteria either being ‘carried’ by antigen-presenting cells or entering by active invasion.
Angiographic changes in the hepatic artery after skeletonization resection for biliary tract cancer
Authors: Yuasa N , Nimura Y , Hayakawa N , Kamiya J , Kondo S , Nagino M 
Published: March 2007

Abstract
Using preoperative and postoperative arteriography, angiographic changes in the hepatic artery were studied after skeletonization of the hepatoduodenal ligament and hepatic resection for biliary tract carcinoma. Of 52 patients evaluated (32 with carcinoma of the bile duct, 20 with gallbladder cancer), no angiographic changes were apparent after operation in 30 (58 per cent) and there were pathological findings in 22 (42 per cent; smooth stenosis in five patients, irregular stenosis in seven, a beaded appearance in four, dilatation in two, obstruction in four). Based on angiographic findings, patients were classified into three subgroups (no change, 30 patients; irregular form, 18; obstructed, four). Postoperative liver function was also evaluated. No definite correlation was evident between angiographic findings and the incidence of hepatic failure or liver dysfunction in the first month after operation. Given that connective tissue and lymph node dissection in the hepatoduodenal ligament is essential for curative resection of biliary tract carcinoma, these findings suggest that skeletonization is an acceptable operative procedure.
Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: Physiological evidence from ambulatory monitoring
Authors: Farouk R , Duthie G S , Pryde A , Bartolo D C C 
Published: March 2007

Abstract
Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27–64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26–68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18–60) versus 18 (11–37) cmH2O, P &lt; 0·01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15–52) versus 29 (21–43) cmH2O, P &lt; 0·01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18–55) versus 8 (5–12) s, P &lt; 0·001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation.
Ischaemia-reperfusion injury
Authors: Grace P A 
Published: March 2007

Abstract
Ischaemia-reperfusion injury is a complex phenomenon often encountered in surgical practice. The consequences of such injury are local and remote tissue destruction, and sometimes death. Several different processes have been implicated. This review discusses the pathology of such injury, the mechanisms of free radical production, and the role of neutrophils and endothelial factors in ischaemiareperfusion. Finally, several mechanisms that limit ischaemiareperfusion injury are discussed and a number of novel therapies presented.
Intravenous digital subtraction angiography versus computed tomography in the assessment of abdominal aortic aneurysm
Authors: Salaman R A , Shandall A , Morgan R H , Fligelstone L , Davies W T , Lane I F 
Published: March 2007

Abstract
Results of preoperative investigation of 127 patients who underwent elective aortic aneurysm repair during a 3-year period were examined and compared with findings at operation. The accuracy of preoperative computed tomography (CT) and intravenous digital subtraction angiography (DSA) in assessing proximal and distal aneurysm extent was compared. From a total of 118 CT scans, ten of 12 suprarenal aneurysms were correctly predicted, with 11 false positives (positive predictive value 48 per cent, sensitivity 83 per cent, specificity 90 per cent). After 103 DSA investigations, six of ten suprarenal aneurysms were correctly predicted with one false positive (positive predictive value 86 per cent, sensitivity 60 per cent, specificity 99 per cent). Using CT, 30 of 54 aneurysmal iliac arteries were correctly diagnosed with 20 false positives (positive predictive value 60 per cent, sensitivity 56 per cent, specificity 88 per cent). Thirty-six of 48 aneurysmal iliac arteries were diagnosed correctly using DSA, with 32 false positives (positive predictive value 53 per cent, sensitivity 75 per cent, specificity 79 per cent). Intravenous DSA also provided useful information about renal and peripheral occlusive disease. Both investigations have their own specific limitations; clinicians should be aware of these when ordering and interpreting them.
Surgical treatment of insulinoma
Authors: Pedrazzoli S , Pasquali C , D'Andrea A Alfano 
Published: March 2007

Abstract
The role of preoperative and intraoperative procedures for the localization of insulinoma has been extensively debated. Transhepatic portal vein sampling before surgery has been recommended when other tests fail to localize the tumour. To determine the role of different investigations, 53 patients with insulinoma, four with hyperplasia or nesidioblastosis and one with insulin autoimmune syndrome were studied. Patients were operated on in three consecutive periods during each of which a different localization procedure was considered to represent the ‘gold standard’. During the first period, of 16 patients (including one with hyperplasia) investigated by arteriography, 13 underwent successful resection. Tumours in the other three patients with insulinoma were resected at a second operation, one during the first period and one each during the second and third periods. During the second period, 28 patients underwent exploration after transhepatic portal sampling: the tumour was found in all 26 patients with insulinoma operated on in this hospital, one patient with hyperplasia is receiving medical treatment and one patient had unsuccessful surgical exploration elsewhere despite positive findings on arteriography and transhepatic portal sampling performed in this department. During the third period 13 procedures were performed. All were successful using intraoperative ultrasonography without transhepatic portal sampling. In three further patients intraoperative localization failed because of non-adenomatous β cell disease. Left-sided resection successfully cured symptoms in two patients with hyperplasia and prompted the diagnosis of insulin autoimmune syndrome. High success rates for surgical treatment of insulinoma can be achieved with transhepatic portal vein sampling or intraoperative ultrasonography. Transhepatic portal sampling is therefore unnecessary before a first operation on the pancreas for insulinoma. In the rare failures of intraoperative localization of an insulinoma, a small left pancreatic resection can help to distinguish insulinoma from hyperplasia without precluding further segmental resection.
Long-term human vein graft contractility and morphology: A functional and histopathological study of retrieved coronary vein grafts
Authors: Cross K S , Davies M G , El-Sanadiki M N , Murray J J , Mikat E M , Hagen P-O 
Published: March 2007

Abstract
Vasoreactivity of 11 coronary artery vein bypass grafts and 13 human saphenous veins was examined. Isometric tension studies were performed in response to potassium chloride (110 mmol/l), noradrenaline (10−9–10−4 mol/l), serotonin (10−9–10−4 mol/l) and histamine (10−8–10−2 mol/l). After precontraction with noradrenaline (10−5 mol/l), the response to acetylcholine (10−8–10−4 mol/l) and the calcium ionophore A23187 (10−8–10−4 mol/l) was also assessed. Results are given as mean(s.e.m.). Compared with saphenous veins, vein grafts showed decreased sensitivity to noradrenaline (1·7(0·5) versus 04(0·1) μmol/l, P = 0·01), no change in sensitivity to serotonin (55(18) versus 37(15) μmol/l, P&gt;0·05) and supersensitivity to histamine (3·2(0·9) versus 30·1(13·2) μmol/l, P=0·01). Vein grafts had a decreased maximal contraction to potassium chloride (1·1(0·3) versus 5·5(0·8)g, P = 0·0001), noradrenaline (1·2(0·3) versus 4·1(0·8)g, P = 0·005), histamine (1·2(0·3) versus 4·5(0·8)g, P = 0·003) and serotonin (0·7(0·2) versus 5·7(0·6)g, P = 0·0002) compared with saphenous vein. Precontracted vein grafts did not relax in response to acetylcholine; in contrast, saphenous vein relaxed in a done-dependent manner to a maximal relaxation of 22(3) per cent. Both saphenous vein and vein graft relaxed in response to A23187. Vein graft intimal thickness was approximately fourfold greater than that of saphenous vein (540(110) versus 136(30)μm). Scanning electron microscopy of vein and vein graft revealed an intact endothelium. Coronary artery vein grafts are capable of responding to various contractile agonists; these responses are notably different from those of saphenous vein and there is a loss of endothelium-dependent relaxation. Even at a late stage vein grafts are not inert but are functional conduits with an abnormally responsive endothelium and a less potent, but significantly altered, smooth muscle contractile profile.
Screening for abdominal aortic aneurysm in Northumberland
Authors: Holdsworth J D 
Published: March 2007

Abstract
A study was carried out to examine the feasibility of setting up a community-based screening programme for abdominal aortic aneurysm (AAA) in men aged 65–79 years served by a district general hospital. A pilot project was run in two general practices from which 800 men were invited to undergo ultrasonography of the abdominal aorta. Of these, 628 (78·5 per cent) attended; 42 (6·7 per cent) were found to have an aneurysm (aortic diameter greater than 29 mm), ten (1·6 per cent) had a large aneurysm (diameter above 49 mm) and seven (1·1 per cent) received aortic grafts. On the basis of these findings it was felt that to screen all men aged 65–79 years (n = 12800) or aged 65–74 years (n = 10300) would lead to more operations than local facilities could handle. A more practical option would be to target annually men aged 65 years, with rescreening at intervals of 5 years until age 75 years, but even this would eventually lead to an unmanageable number of operations.
Life-table analysis of stomal complications following ileostomy
Authors: Leong A P K , Londono-Schimmer E E , Phillips R K S 
Published: March 2007

Abstract
Stomal complications of ileostomy may occur many years after construction. An actuarial analysis of complications of 150 permanent end ileostomies constructed over a 10-year period is reported. By 20 years the incidence of stomal complications approached 76 per cent in patients operated on for ulcerative colitis and 59 per cent in those with Crohn's disease (P &lt; 0·05). Revisional surgery rates were higher in patients with ulcerative colitis than in those with Crohn's disease (28 versus 16 per cent), albeit not significantly. The four commonest complications were skin problems (cumulative probability 34 per cent), intestinal obstruction (23 per cent), retraction (17 per cent) and parastomal herniation (16 per cent). Closure of the lateral space did not reduce the probability of developing intestinal obstruction (18 per cent at 20 years in those with closure versus 3 per cent in those without, P gt; 0·1). Fixation of the mesentery did not reduce the probability of developing prolapse of the ileostomy (11 per cent in those with fixation versus none in those without, P &lt; 0·1). The incidence of parastomal herniation was not reduced by siting through the rectus abdominis (21 per cent in those sited through the body of the rectus abdominis versus 7 per cent in those sited through the oblique muscles, P &lt; 0·1). Some of the surgical dogmas relating to ileostomy construction are not supported by the results of this study.
Rectoanal inhibition and incontinence in patients with rectal prolapse
Authors: Farouk R , Duthie G S , Macgregor A B , Bartolo D C C 
Published: March 2007

Abstract
Thirty-five patients with complete rectal prolapse, 32 with neurogenic faecal incontinence and 33 controls underwent ambulatory recording using a computerized anal electromyographic and anorectal manometry system. Median resting anal pressures were 34 cmH2O in patients with prolapse, 51 cmH2O in those with neurogenic faecal incontinence and 94 cmH2O in controls. Median basal rectal pressures were 18, 21 and 21 cmH2O respectively. High-pressure rectal waves of median amplitude 71 cmH2O lasting 30–150 s and associated with inhibition of the electromyographic activity of the internal anal sphincter and a fall in anal pressures were seen in all patients with prolapse but not in controls or those with neurogenic incontinence. These waves were abolished following successful resection rectopexy. Recovery of continence occurs by abolition of high-pressure rectal waves, which produce maximal inhibition of sphincter activity before operation.
Neutrophils may contribute to the morbidity and mortality of claudicants
Authors: Hickman P , McCollum P T , Belch J J F 
Published: March 2007

Abstract
Peripheral arterial occlusive disease is a common cause of morbidity in middle-aged men; 5 per cent of those aged over 50 years suffer from intermittent claudication. While claudication itself is not fatal, claudicants have a mortality rate approximately three times that of non-claudicating men of the same age, mainly from cardiovascular disease. This review examines the evidence for involvement of the neutrophil in this increased mortality and describes the possible pathogenesis. It also discusses how treatment of claudication may modify neutrophil behaviour, reducing subsequent mortality and morbidity rates.
Management of bile duct stones in the era of laparoscopic cholecystectomy
Authors: Perissat J , Huibregtse K , Keane F B V , Russell R C G , Neoptolemos J P 
Published: March 2007

Abstract
The introduction of laparoscopic cholecystectomy has resulted in increased options for the management of bile duct stones and has stimulated a fundamental reappraisal of the situation before the laparoscopic era. This article reviews the natural history of bile duct stones and details the different ways in which they may now be treated. New areas of controversy are highlighted and the need for further studies is emphasized.
Influence of Losartan, an angiotensin receptor antagonist, on neointimal proliferation in cultured human saphenous vein
Authors: Varty K , Allen K E , Jones L , Sayers R D , Bell P R F , London N J M 
Published: March 2007

Abstract
An organ culture of human saphenous vein was used as a model of vein graft intimal hyperplasia and the potential of Losartan, an angiotensin II receptor antagonist, to inhibit neointimal proliferation was investigated. Median (range) neointimal thickness was reduced from 17 (16–19) to 11 (8–18) μm in veins cultured with Losartan (median difference 5 (95 per cent confidence interval 2–8) μm). A similar decrease in the median neointimal proliferation index was seen from 21 (range 14–47) to 15 (range 5–31) per cent (median difference 8 per cent (95 per cent confidence interval 5–11 per cent)). These results demonstrate that angiotensin II receptor antagonists may be of therapeutic value for the modulation of vein graft intimal hyperplasia.
Diagnosis of intracranial occlusive disease before carotid endarterectomy: Preliminary experience with transcranial colour-flow Doppler ultrasonography
Authors: Martin P J , Gaunt M E , Naylor A R , Bell P R F 
Published: March 2007

Abstract
Transcranial colour-coded Doppler ultrasonography allows both imaging and simultaneous haemodynamic investigation of the basal cerebral arteries. Four of 16 patients undergoing carotid endarterectomy were found to have intracerebral artery stenotic disease by use of this technique. Discrete stenotic segments were recognized by their markedly raised blood flow velocities with damping of the spectral Doppler waveform distally. Colour-coded transcranial Doppler ultrasonography used in conjunction with extracranial duplex imaging might provide an effective and safe alternative to angiography.
Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy
Authors: Wilson Y G , Allen P E , Skidmore R , Baker A R 
Published: March 2007

Abstract
Lower-limb venous haemodynamics were studied prospectively in 40 patients (24 women, 16 men of median age 52 years) undergoing laparoscopic cholecystectomy. Patients were randomized to wear compression stockings during surgery or no stockings. All received subcutaneous heparin prophylaxis. Venous capacitance and outflow were measured non-invasively before, during and after pneumo-peritoneum. In the group without compression stockings (20 patients) venous capacitance and outflow decreased during pneumoperitoneum in most patients. In the group wearing stockings (20 patients) the changes were less pronounced or abolished. There was a significant difference between the groups in venous capacitance and outflow ratios at mid-operation: median (interquartile range) 0·89 (0·56–1·16) and 0·89 (0·56–1·15) respectively in the group without stockings versus 1·48 (1·09–2·19) and 1·71 (1·20–2·19) respectively in that with stockings (P &lt; 0·001). Pneumoperitoneum creates a significant resistance to venous return. Compression stockings counteract the changes observed.
Multicentre audit of death from acute pancreatitis
Authors: Mann D V , Hershman M J , Hittinger R , Glazer G 
Published: March 2007

Abstract
A prospective audit of acute pancreatitis involving nine hospitals in the North-West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty-nine patients (68 per cent) died after the first week from complications related to infection (26 patients), co-morbid conditions (nine) or non-infective complications (four). Twenty-one patients (42 per cent) had been inadequately evaluated by Ranson's criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection-related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.